Provider Demographics
NPI:1669258802
Name:RUTHERFORD, TAYLOR RENEE (CRNP, FNP-C)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RENEE
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:CRNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3910
Mailing Address - Country:US
Mailing Address - Phone:814-932-0244
Mailing Address - Fax:
Practice Address - Street 1:1120 PIKE ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1117
Practice Address - Country:US
Practice Address - Phone:814-643-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty