Provider Demographics
NPI:1013558030
Name:RUTHERFORD, MISHELE M (ARNP)
Entity Type:Individual
Prefix:
First Name:MISHELE
Middle Name:M
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MISHELE
Other - Middle Name:M
Other - Last Name:BANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8210 SPOKANE DR APT 203
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-6760
Mailing Address - Country:US
Mailing Address - Phone:206-743-1020
Mailing Address - Fax:
Practice Address - Street 1:20508 56TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7650
Practice Address - Country:US
Practice Address - Phone:206-743-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61004262363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health