Individual
MS. RENEE N RUTHERFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
916 TALON DR, SUITE 102, O FALLON, IL 62269-1848
(618) 628-8211
(618) 628-0883
Mailing address
916 TALON DR, SUITE 102, O FALLON, IL 62269-1848
(618) 628-8211
(618) 628-0883
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-003107
IL
Other
Enumeration date
10/18/2007
Last updated
08/21/2008
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