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Individual

GAIL L. RUTAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71001551A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200534870
IN
01
PENDING
ANTHEM PROVIDER NUMBER
IN
Enumeration date
05/24/2006
Last updated
03/26/2009
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