Provider Demographics
NPI:1821555160
Name:RUTHERFORD, ANGELA PERROU (MS, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:PERROU
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 ORTIN LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7240
Mailing Address - Country:US
Mailing Address - Phone:919-622-9409
Mailing Address - Fax:
Practice Address - Street 1:4709 CREEKSTONE DR STE 300
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-0016
Practice Address - Country:US
Practice Address - Phone:919-385-7877
Practice Address - Fax:919-576-8806
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001920133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric