Provider Demographics
NPI:1275980443
Name:RUTHERFORD, TIA MARIE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:TIA
Middle Name:MARIE
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MISS
Other - First Name:TIA
Other - Middle Name:MARIE
Other - Last Name:GRUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:329 N WEST ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4332
Mailing Address - Country:US
Mailing Address - Phone:419-221-3072
Mailing Address - Fax:419-549-5670
Practice Address - Street 1:200 HARDING AVE
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1669
Practice Address - Country:US
Practice Address - Phone:419-679-5994
Practice Address - Fax:419-225-8878
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP19377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily