Provider Demographics
NPI:1013110428
Name:RUTTER, DAVID ALLAN (RN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLAN
Last Name:RUTTER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 STERLING GROVE DR
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-2433
Mailing Address - Country:US
Mailing Address - Phone:209-712-0661
Mailing Address - Fax:
Practice Address - Street 1:1588 E MARCH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-5669
Practice Address - Country:US
Practice Address - Phone:207-474-7881
Practice Address - Fax:913-814-4525
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425261163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse