Provider Demographics
NPI:1598511479
Name:RUTLEDGE, TAMARA DENISE I (LPN)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:DENISE
Last Name:RUTLEDGE
Suffix:I
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2250 WEHRLE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7034
Mailing Address - Country:US
Mailing Address - Phone:716-276-2123
Mailing Address - Fax:716-276-2129
Practice Address - Street 1:2250 WEHRLE DR STE 1
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-7034
Practice Address - Country:US
Practice Address - Phone:716-276-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320893-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse