Provider Demographics
NPI:1982246682
Name:RUTLAND, MYRA LYNN (DNP)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:LYNN
Last Name:RUTLAND
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:DR
Other - First Name:MYRA
Other - Middle Name:LYNN
Other - Last Name:UNDERWOOD-RUTLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:198 BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1865
Mailing Address - Country:US
Mailing Address - Phone:610-299-1615
Mailing Address - Fax:
Practice Address - Street 1:5201 HAVERFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-1401
Practice Address - Country:US
Practice Address - Phone:215-472-6097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily