Provider Demographics
NPI:1134448459
Name:RUTHERFORD, KRISTIN L (FNP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 SENECA ST
Mailing Address - Street 2:STE 2
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2653
Mailing Address - Country:US
Mailing Address - Phone:315-361-1041
Mailing Address - Fax:315-361-1044
Practice Address - Street 1:603 SENECA ST
Practice Address - Street 2:STE 2
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2653
Practice Address - Country:US
Practice Address - Phone:315-361-1041
Practice Address - Fax:315-361-1044
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336386363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03241912Medicaid
NYJ400063484Medicare PIN