Provider Demographics
NPI:1194524702
Name:RUTAN, KRISTIN (APN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:RUTAN
Suffix:
Gender:
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 YVONNE WAY
Mailing Address - Street 2:
Mailing Address - City:STEWARTSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08886-3216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 YVONNE WAY
Practice Address - Street 2:
Practice Address - City:STEWARTSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08886-3216
Practice Address - Country:US
Practice Address - Phone:908-938-0956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15220900363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care