Provider Demographics
NPI:1083454664
Name:RUTHRUFF, SARA LIN (CRNA)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:LIN
Last Name:RUTHRUFF
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 1:934 FAIRMOUNT ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1507
Mailing Address - Country:US
Mailing Address - Phone:616-902-4925
Mailing Address - Fax:
Practice Address - Street 1:934 FAIRMOUNT ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1507
Practice Address - Country:US
Practice Address - Phone:616-902-4925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704305443367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered