Provider Demographics
NPI:1316167786
Name:RUTHERFORD, DIANA LINN (LPN)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:LINN
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8285 WILHITE DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9267
Mailing Address - Country:US
Mailing Address - Phone:330-334-2648
Mailing Address - Fax:
Practice Address - Street 1:8285 WILHITE DR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9267
Practice Address - Country:US
Practice Address - Phone:330-334-2648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN092335164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH092335OtherPRACTICAL NURSING LICENSE
OH2137753Medicaid