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NPI Code Detail

MEDICARE: MRS. BRENDA RAE RUTHERFORD CRNA

MEDICARE: MRS. BRENDA RAE RUTHERFORD CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistR0081080OK
2367500000XCertified Registered Nurse Anesthetist2002021268MO

General Provider Information

NPI Number : 1154326874
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BRENDA RAE RUTHERFORD CRNA
Provider Business Mailing Address
First Line : 209 NW NORTH RIDGE DRIVE, SUITE B
Second Line : ANESTHESIA SERVICES OF BLUE SPRINGS
City : BLUE SPRINGS
State : MO
Zip : 64015-6320
Country : US
Telephone Number : 816-988-8415
Fax Number : 816-988-8395
Provider Business Practice Location Address
First Line : 209 NW NORTH RIDGE DRIVE, SUITE B
Second Line : ANESTHESIA SERVICES OF BLUE SPRINGS
City : BLUE SPRINGS
State : MO
Zip : 64015-6320
Country : US
Telephone Number : 816-988-8415
Fax Number : 816-988-8395
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 01/28/2014

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