Provider Demographics
NPI:1346357340
Name:RUTHERFORD, ANNE FULLER (APRN)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:FULLER
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:FULLER
Other - Last Name:RUTHERFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:9 OLD HILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3014
Mailing Address - Country:US
Mailing Address - Phone:203-981-9001
Mailing Address - Fax:203-454-3252
Practice Address - Street 1:9 OLD HILL RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880
Practice Address - Country:US
Practice Address - Phone:203-981-9001
Practice Address - Fax:203-981-9001
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002130OtherLICENSE NUMBER