Provider Demographics
NPI:1942359732
Name:RUTLEDGE, JAN E (RN)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:E
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 LUCAS LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-1181
Mailing Address - Country:US
Mailing Address - Phone:920-674-6166
Mailing Address - Fax:
Practice Address - Street 1:N68W35460 COUNTY ROAD K
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-1210
Practice Address - Country:US
Practice Address - Phone:262-966-2702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI80968-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health