Provider Demographics
NPI:1770758484
Name:RUTHERFORD, MARY CLAIRE (ARNP, MSN, MPH)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CLAIRE
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:ARNP, MSN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11120 GRAVELLY LAKE DR. SUITE #10
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499
Mailing Address - Country:US
Mailing Address - Phone:253-584-4556
Mailing Address - Fax:
Practice Address - Street 1:11120 GRAVELLY LAKE DR SW STE 10
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1351
Practice Address - Country:US
Practice Address - Phone:253-584-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily