Provider Demographics
NPI:1063214427
Name:RUTLEY, LATOYA MARIE (AAS)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:MARIE
Last Name:RUTLEY
Suffix:
Gender:
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 W DEER RUN DR APT 104
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-6404
Mailing Address - Country:US
Mailing Address - Phone:414-477-9927
Mailing Address - Fax:
Practice Address - Street 1:4460 W DEER RUN DR APT 104
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-6404
Practice Address - Country:US
Practice Address - Phone:414-477-9927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI92-3696216374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide