Provider Demographics
NPI:1992337851
Name:RUTKOWSKI, AMBER (CRNP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:RUTKOWSKI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11630 HONEY RUN LN
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-8241
Mailing Address - Country:US
Mailing Address - Phone:313-333-4571
Mailing Address - Fax:
Practice Address - Street 1:1125 OPAL CT # 1004
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5934
Practice Address - Country:US
Practice Address - Phone:866-808-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-09
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN653777163W00000X
PASP021564363LF0000X
MDR208199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse