Provider Demographics
NPI:1992746341
Name:RUTKOSKI, LAUREN ELIZABETH (PA-C)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:RUTKOSKI
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5144 SHERIDAN DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4648
Mailing Address - Country:US
Mailing Address - Phone:716-632-2311
Mailing Address - Fax:716-632-3140
Practice Address - Street 1:5144 SHERIDAN DR
Practice Address - Street 2:SUITE 5
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4648
Practice Address - Country:US
Practice Address - Phone:716-632-2311
Practice Address - Fax:716-632-3140
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-09-14
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Provider Licenses
StateLicense IDTaxonomies
NY018291363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1992746341Medicare NSC