Provider Demographics
NPI:1336125111
Name:RUTLEDGE, BEVERLY A (WHCNP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 W 36TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2758
Mailing Address - Country:US
Mailing Address - Phone:952-807-0415
Mailing Address - Fax:952-236-6461
Practice Address - Street 1:5000 W 36TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2758
Practice Address - Country:US
Practice Address - Phone:952-807-0415
Practice Address - Fax:952-236-6461
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNRUT104299027363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health