Provider Demographics
NPI:1801253588
Name:RUTLEDGE, LISA (LM, CPM)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 S PATHFINDERS CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3053
Mailing Address - Country:US
Mailing Address - Phone:832-978-4577
Mailing Address - Fax:
Practice Address - Street 1:272 S PATHFINDERS CIR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3053
Practice Address - Country:US
Practice Address - Phone:832-978-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99256176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife