Basic Information
| Provider Information | |||||||||
| NPI: | 1144872763 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUTAGENGWA | ||||||||
| FirstName: | SOLANGE | ||||||||
| MiddleName: | UMUTESI | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5909 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972285909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742736767 | ||||||||
| FaxNumber: | 5749687160 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 PARK PL | ||||||||
| Address2: | |||||||||
| City: | MISHAWAKA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465453519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742736767 | ||||||||
| FaxNumber: | 5749687160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2019 | ||||||||
| LastUpdateDate: | 04/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2019039563 | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 2019039563 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 71009342A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.