Provider Demographics
NPI:1790066637
Name:RUTHERFORD, DEVON MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DEVON
Middle Name:MARIE
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ENGLISH CREEK AVE
Mailing Address - Street 2:BLDG 500, STE 501
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234
Mailing Address - Country:US
Mailing Address - Phone:609-833-4410
Mailing Address - Fax:609-829-8061
Practice Address - Street 1:2500 ENGLISH CREEK AVE
Practice Address - Street 2:BLDG 500, STE 501
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234
Practice Address - Country:US
Practice Address - Phone:609-833-4410
Practice Address - Fax:609-829-8061
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00369700363A00000X
MDC0004496363AM0700X
WAPA60863546363AM0700X
VA0110003616363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ17900666397Other