Provider Demographics
NPI:1366078008
Name:RUTLEDGE, JOHN CHRISTIAN
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHRISTIAN
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 LAKE POINTE DR.
Mailing Address - Street 2:PRIVATE
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953
Mailing Address - Country:US
Mailing Address - Phone:631-223-6739
Mailing Address - Fax:
Practice Address - Street 1:432 LAKE POINTE DR
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2033
Practice Address - Country:US
Practice Address - Phone:631-223-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY497665163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse