Provider Demographics
NPI:1063274025
Name:RUTHERFORD, MELISSA JEAN (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 N USERY PASS RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-1578
Mailing Address - Country:US
Mailing Address - Phone:480-980-3238
Mailing Address - Fax:
Practice Address - Street 1:1148 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5971
Practice Address - Country:US
Practice Address - Phone:480-559-3149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ300743208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice