Provider Demographics
NPI:1699665588
Name:RETHERFORD, ANICA M
Entity type:Individual
Prefix:MRS
First Name:ANICA
Middle Name:M
Last Name:RETHERFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2889 SAN LORENZO CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-1969
Mailing Address - Country:US
Mailing Address - Phone:575-649-4403
Mailing Address - Fax:
Practice Address - Street 1:2889 SAN LORENZO CT
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-1969
Practice Address - Country:US
Practice Address - Phone:575-649-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM172V00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No172V00000XOther Service ProvidersCommunity Health Worker