Basic Information
| Provider Information | |||||||||
| NPI: | 1962763995 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUTKOSKIE | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 S CEDAR CREST BLVD STE 301 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104029099 | ||||||||
| FaxNumber: | 6104029029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1245 S CEDAR CREST BLVD STE 301 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181036258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104029099 | ||||||||
| FaxNumber: | 6104029029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2012 | ||||||||
| LastUpdateDate: | 03/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN556259 | PA | N | Nursing Service Providers | Registered Nurse | 367500000X | 90621 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 50108906 | 01 | PA | CAPITAL ADVANTAGE | OTHER | 1027809600001 | 05 | PA | MEDICAID | 3881804000 | 01 | PA | IND. BLUE CROSS | OTHER | 2707202 | 01 | PA | FIRST PRIORITY | OTHER | 12389010 | 01 | PA | CAQH | OTHER | 1608903 | 01 | PA | GATEWAY | OTHER | 1962763995 | 01 | PA | GEISINGER | OTHER | 9761876 | 01 | PA | AETNA | OTHER | 2707202 | 01 | PA | HIGHMARK | OTHER |