Provider Demographics
NPI:1275877474
Name:RUTHERFORD, AMANDA D (APN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:D
Other - Last Name:TINUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:85 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1827
Mailing Address - Country:US
Mailing Address - Phone:201-930-1700
Mailing Address - Fax:
Practice Address - Street 1:85 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1827
Practice Address - Country:US
Practice Address - Phone:201-930-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00402600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily