Provider Demographics
NPI:1538613666
Name:RUTTA, ANGELA KARI (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KARI
Last Name:RUTTA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:KARI
Other - Last Name:SANDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5458 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54466
Mailing Address - Country:US
Mailing Address - Phone:715-897-3335
Mailing Address - Fax:
Practice Address - Street 1:5458 2ND AVE
Practice Address - Street 2:
Practice Address - City:PITTSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54466
Practice Address - Country:US
Practice Address - Phone:715-897-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32039931164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse