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Individual

LISA MARIE RUTHERFORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
2085 FRONTIS PLAZA BLVD, WINSTON SALEM, NC 27103-5614
(704) 316-4136
(704) 316-9208
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5007387
NC

Other

Enumeration date
01/09/2015
Last updated
11/17/2021
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