Provider Demographics
NPI:1487136578
Name:RUTKOWSKI, BONITA (IBCLC)
Entity type:Individual
Prefix:
First Name:BONITA
Middle Name:
Last Name:RUTKOWSKI
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:GOTTSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 W BETH WALD ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-0707
Mailing Address - Country:US
Mailing Address - Phone:915-490-9147
Mailing Address - Fax:
Practice Address - Street 1:212 W BETH WALD ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-0707
Practice Address - Country:US
Practice Address - Phone:915-490-9147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-108420174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN