Provider Demographics
NPI:1821883018
Name:RUTTER, BRIANNA SHANTE
Entity type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:SHANTE
Last Name:RUTTER
Suffix:
Gender:
Credentials:
Other - Prefix:MS
Other - First Name:BRIANNA
Other - Middle Name:SHANTE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:940 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-2512
Mailing Address - Country:US
Mailing Address - Phone:937-508-8601
Mailing Address - Fax:
Practice Address - Street 1:10400 BLACKLICK EASTERN RD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8235
Practice Address - Country:US
Practice Address - Phone:937-508-8601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0487170Medicaid