Provider Demographics
NPI:1154326874
Name:RUTHERFORD, BRENDA RAE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:RAE
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:RAE
Other - Last Name:CRONK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:209 NW NORTH RIDGE DRIVE, SUITE B
Mailing Address - Street 2:ANESTHESIA SERVICES OF BLUE SPRINGS
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-6320
Mailing Address - Country:US
Mailing Address - Phone:816-988-8415
Mailing Address - Fax:816-988-8395
Practice Address - Street 1:209 NW NORTH RIDGE DRIVE, SUITE B
Practice Address - Street 2:ANESTHESIA SERVICES OF BLUE SPRINGS
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-6320
Practice Address - Country:US
Practice Address - Phone:816-988-8415
Practice Address - Fax:816-988-8395
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0081080367500000X
MO2002021268367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered