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General NPI Number Information
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NPI Number | 1992465710
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Entity Type | Individual
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Provider Name | CHARLES ANTHONY RUTHERFORD RN
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Gender | Male
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Dates
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Enumeration Date | 12/20/2021
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 720 WOOD ST
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City | EUREKA
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State | CA
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Zip | 95501-4413
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Country | US
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Telephone | 707-268-2990
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Fax |
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Provider Business Mailing Address
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Address Line | 581 BLUE RIDGE TRL
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City | MORGANTON
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State | GA
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Zip | 30560-2683
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Country | US
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Telephone | 706-400-0981
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Fax | 706-374-4209
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 95219778
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License Number State | CA
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