1871243964 NPI number — MRS. KERRY CATHERINE RUTLAND MPA

Table of content: MRS. KERRY CATHERINE RUTLAND MPA (NPI 1871243964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871243964 NPI number — MRS. KERRY CATHERINE RUTLAND MPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUTLAND
Provider First Name:
KERRY
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLS
Provider Other First Name:
KERRY
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871243964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 EATON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKVILLE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06779-1250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-417-2521
Provider Business Mailing Address Fax Number:
860-631-1054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 EATON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKVILLE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06779-1250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-471-2521
Provider Business Practice Location Address Fax Number:
860-631-1054
Provider Enumeration Date:
03/24/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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