Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 21086 | TN |
NPI | 1003260191 |
---|---|
Provider Name | Connie Rutledge |
First Address | Church Hill, TN 37642-7170 |
Second Address | Weber City, VA 24290-7071 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2016 |
Last Update Date | 30/04/2019 |