Provider Demographics
NPI:1679108500
Name:RUTZEN, JENNIFER ANN (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:RUTZEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 MONTEBELLO AVE
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-8208
Mailing Address - Country:US
Mailing Address - Phone:517-881-3347
Mailing Address - Fax:
Practice Address - Street 1:3960 PATIENT CARE DR STE 109
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4276
Practice Address - Country:US
Practice Address - Phone:517-574-5645
Practice Address - Fax:517-574-5688
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704289373363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care