Provider Demographics
NPI:1427709237
Name:RUTHERFORD, CAROLYN (RN, BSN, CCM)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:RN, BSN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1391 NW 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323
Mailing Address - Country:US
Mailing Address - Phone:484-302-1342
Mailing Address - Fax:770-723-8620
Practice Address - Street 1:1391 NW 136TH AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323
Practice Address - Country:US
Practice Address - Phone:484-302-1342
Practice Address - Fax:770-723-8620
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN304402L163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management