Provider Demographics
NPI:1467288464
Name:RUTKOWSKI, AUDREY (DNP, RN, AGCNS-BC)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:RUTKOWSKI
Suffix:
Gender:F
Credentials:DNP, RN, AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S TALBOT ST
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:MI
Mailing Address - Zip Code:49220-9639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-205-2638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2024065086364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care