Provider Demographics
NPI:1962763995
Name:RUTKOSKIE, SAMANTHA J (CRNA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:RUTKOSKIE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1245 S CEDAR CREST BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1245 S CEDAR CREST BLVD STE 301
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6258
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN556259163W00000X
PA90621367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50108906OtherCAPITAL ADVANTAGE
PA1027809600001Medicaid
PA3881804000OtherIND. BLUE CROSS
PA2707202OtherFIRST PRIORITY
PA12389010OtherCAQH
PA1608903OtherGATEWAY
PA1962763995OtherGEISINGER
PA9761876OtherAETNA
PA2707202OtherHIGHMARK
PA1027809600001Medicaid