Provider Demographics
NPI:1194234146
Name:RUTTINO, JACKIE RAE (NP-C)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:RAE
Last Name:RUTTINO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8432 STATE ROUTE 18
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9549
Mailing Address - Country:US
Mailing Address - Phone:419-706-0071
Mailing Address - Fax:
Practice Address - Street 1:5420 MILAN RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5846
Practice Address - Country:US
Practice Address - Phone:419-557-5052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021753363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner