Provider Demographics
NPI:1790821643
Name:RUTLAND, WARREN
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:RUTLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:KS
Mailing Address - Zip Code:66434-9378
Mailing Address - Country:US
Mailing Address - Phone:785-547-3446
Mailing Address - Fax:
Practice Address - Street 1:208 HUDSON ST
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:KS
Practice Address - Zip Code:66434-9378
Practice Address - Country:US
Practice Address - Phone:785-547-3446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant