Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 66921-20 | WI |
Y | 111NI0900X | Internist | 66921-20 | WI |
NPI | 1003228743 |
---|---|
Provider Name | Charlotte Rebecca Rutkowski |
First Address | Brewer, ME 04412-1005 |
Second Address | Amery, WI 54001-1439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2014 |
Last Update Date | 21/08/2017 |