Healthcare Provider Details

I. General information

NPI: 1841284916
Provider Name (Legal Business Name): JOANNE RUTLAND PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 MCPHERSON ST SUITE 2
NORTH BEND OR
97459-3482
US

IV. Provider business mailing address

1975 MCPHERSON ST SUITE 2
NORTH BEND OR
97459-3482
US

V. Phone/Fax

Practice location:
  • Phone: 541-756-2020
  • Fax:
Mailing address:
  • Phone: 541-756-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number099000440RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: