Individual
ALTHEA SHAWANI RUTHERFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3643 N ROXBORO ST, DURHAM, NC 27704-2702
(919) 470-7153
Mailing address
PO BOX 63362, CHARLOTTE, NC 28263-3362
(919) 684-8111
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001002163
NC
363A00000X
Physician Assistant
0109211
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131740114
MONTEFIORE MEDICAL CENTER
NY
Enumeration date
06/15/2007
Last updated
01/08/2015
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