Provider Demographics
NPI:1861860983
Name:MCKINNEY, RUTHELL RENEE (FNP)
Entity type:Individual
Prefix:
First Name:RUTHELL
Middle Name:RENEE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:RUTHELL
Other - Middle Name:RENEE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3136 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-1723
Mailing Address - Country:US
Mailing Address - Phone:414-807-3491
Mailing Address - Fax:
Practice Address - Street 1:3136 N 21ST ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206-1723
Practice Address - Country:US
Practice Address - Phone:414-807-3491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6640-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily