Provider Demographics
NPI:1508975517
Name:RUTLEDGE-HILBURN, BRENDA (CRNA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:RUTLEDGE-HILBURN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2521
Mailing Address - Country:US
Mailing Address - Phone:318-376-1312
Mailing Address - Fax:
Practice Address - Street 1:2108 ISLAND DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2521
Practice Address - Country:US
Practice Address - Phone:318-376-1312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03239367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1544001Medicaid
LA1544001Medicaid
LA5X503CM62Medicare PIN