Provider Demographics
NPI:1922099423
Name:RUTHERFORD, FLO A (CRNA)
Entity Type:Individual
Prefix:MS
First Name:FLO
Middle Name:A
Last Name:RUTHERFORD
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 1:501 ROSIE LN
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19440-1247
Mailing Address - Country:US
Mailing Address - Phone:215-997-7657
Mailing Address - Fax:215-997-0150
Practice Address - Street 1:1335 W TABOR RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3040
Practice Address - Country:US
Practice Address - Phone:215-424-0222
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA30027367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARU787629OtherHIGHMARK BCBS
PARU787629OtherHIGHMARK BCBS
PAS22083Medicare UPIN