Healthcare Provider Details

I. General information

NPI: 1376740993
Provider Name (Legal Business Name): DAVID JASON RUTHERFORD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 BROADVIEW AVE APT. 11
COLUMBUS OH
43212-2835
US

IV. Provider business mailing address

1450 BROADVIEW AVE APT. 11
COLUMBUS OH
43212-2835
US

V. Phone/Fax

Practice location:
  • Phone: 614-487-0436
  • Fax:
Mailing address:
  • Phone: 614-487-0436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN. 325192
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: