Healthcare Provider Details

I. General information

NPI: 1427826106
Provider Name (Legal Business Name): ASHTON PAIGE RUTHERFORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 WASHINGTON ST E
CHARLESTON WV
25311-2511
US

IV. Provider business mailing address

1520 WASHINGTON ST E
CHARLESTON WV
25311-2511
US

V. Phone/Fax

Practice location:
  • Phone: 304-414-5930
  • Fax: 304-414-2200
Mailing address:
  • Phone: 304-414-5930
  • Fax: 304-414-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number112715
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: