Provider Demographics
NPI:1508301276
Name:RUTT, EMILY (CPNP-AC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:RUTT
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:R
Other - Last Name:RUTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPNP-AC
Mailing Address - Street 1:500 UNIVERSITY DR MC CA410
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-5208
Mailing Address - Fax:717-531-0119
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-3558
Practice Address - Fax:717-531-0668
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22137363LP0200X
PASP033191363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics