Individual
BRENNA ADEN RUTHERFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
333 SMITH AVE N, SAINT PAUL, MN 55102-2344
(651) 241-8000
Mailing address
2829 UNIVERSITY AVE SE STE 730, MINNEAPOLIS, MN 55414-3279
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10947
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1098260
PA LICENSURE - NCCPA
MN
Enumeration date
06/11/2011
Last updated
11/02/2023
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