Individual
STACY LYNN RUTHERFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNAP
Contact information
Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3100
Mailing address
5527 NIEMAN RD, SHAWNEE, KS 66203-2345
(918) 633-4820
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
117919
OK
163W00000X
Registered Nurse
138975
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
117919
OK
Other
Enumeration date
05/17/2020
Last updated
03/22/2022
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