Provider Demographics
NPI:1154927333
Name:RUTHERFORD, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11831 LONDON RD
Mailing Address - Street 2:
Mailing Address - City:ORIENT
Mailing Address - State:OH
Mailing Address - Zip Code:43146-9194
Mailing Address - Country:US
Mailing Address - Phone:614-462-9742
Mailing Address - Fax:
Practice Address - Street 1:11831 LONDON RD
Practice Address - Street 2:
Practice Address - City:ORIENT
Practice Address - State:OH
Practice Address - Zip Code:43146-9194
Practice Address - Country:US
Practice Address - Phone:614-462-9724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH49017823747P1801X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care