Individual
RUSSELL RUTHERFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6301 CENTRAL AVE NW, ALBUQUERQUE, NM 87105-2036
(505) 343-1918
Mailing address
8924 SHOSHONE RD NE, ALBUQUERQUE, NM 87111-4624
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/04/2010
Last updated
11/04/2010
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