Provider Demographics
NPI:1912244203
Name:RUTHERFORD, HOPE ELIZABETH (PAC)
Entity Type:Individual
Prefix:MS
First Name:HOPE
Middle Name:ELIZABETH
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:HOPE
Other - Middle Name:ELIZABETH
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4970
Mailing Address - Country:US
Mailing Address - Phone:425-690-2715
Mailing Address - Fax:
Practice Address - Street 1:27500 168TH PL SE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-5563
Practice Address - Country:US
Practice Address - Phone:425-690-3435
Practice Address - Fax:425-690-9435
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60318322363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024880Medicaid