Provider Demographics
NPI:1851992739
Name:RUTKOWSKI, JENNIFER J (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:RUTKOWSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:HUMBRACHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:MINERAL POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53565-0153
Mailing Address - Country:US
Mailing Address - Phone:608-778-2506
Mailing Address - Fax:
Practice Address - Street 1:310 E HIGHWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOPE
Practice Address - State:WI
Practice Address - Zip Code:53816-9796
Practice Address - Country:US
Practice Address - Phone:608-778-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI107845163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse