Provider Demographics
NPI:1841864121
Name:RUTT, NICOLE LINN
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LINN
Last Name:RUTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22346 302ND ST
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:56011-4408
Mailing Address - Country:US
Mailing Address - Phone:952-688-8932
Mailing Address - Fax:
Practice Address - Street 1:6300 W OLD SHAKOPEE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-2654
Practice Address - Country:US
Practice Address - Phone:612-261-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other