Provider Demographics
NPI:1922742741
Name:RUTHERFORD, PAMELA (CERTIFIED NUTRITION)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:CERTIFIED NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6434 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-2715
Mailing Address - Country:US
Mailing Address - Phone:240-385-1411
Mailing Address - Fax:
Practice Address - Street 1:6434 OLD NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-2715
Practice Address - Country:US
Practice Address - Phone:240-385-1411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education