Provider Demographics
NPI:1104402163
Name:RUTKOWSKI, OLIVIA NICOLE (PA)
Entity type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:NICOLE
Last Name:RUTKOWSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:OLIVIA
Other - Middle Name:NICOLE
Other - Last Name:RUTKOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:10 FORESTGLEN CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1359
Mailing Address - Country:US
Mailing Address - Phone:716-697-2341
Mailing Address - Fax:
Practice Address - Street 1:10 FORESTGLEN CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-1359
Practice Address - Country:US
Practice Address - Phone:716-697-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-21
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant