Provider Demographics
NPI:1881084994
Name:RUTTE, MEGAN (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:RUTTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-2000
Mailing Address - Fax:208-302-2055
Practice Address - Street 1:1075 N CURTIS ROAD
Practice Address - Street 2:STE 300
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-302-2000
Practice Address - Fax:208-302-2055
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110-004848363AM0700X
IDPA-1478363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical