Provider Demographics
NPI:1275316275
Name:RUTHERFORD, DIANNA L
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:L
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17850 JUG RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:OH
Mailing Address - Zip Code:44021-9614
Mailing Address - Country:US
Mailing Address - Phone:330-806-9062
Mailing Address - Fax:
Practice Address - Street 1:17850 JUG RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:OH
Practice Address - Zip Code:44021-9614
Practice Address - Country:US
Practice Address - Phone:330-806-9062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide