Provider Demographics
NPI:1578382081
Name:RUTHERFORD, MEGHAN KIMBERLY (FNP-C)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:KIMBERLY
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:KIMBERLY
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2421 STEFF ANN DR
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1522
Mailing Address - Country:US
Mailing Address - Phone:517-745-9579
Mailing Address - Fax:
Practice Address - Street 1:2421 STEFF ANN DR
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1522
Practice Address - Country:US
Practice Address - Phone:517-745-9579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704379269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty