Provider Demographics
NPI:1588892657
Name:RUTHERFORD, ANDREA MORENO
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MORENO
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 1:100 SHATTUCK WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8004
Mailing Address - Country:US
Mailing Address - Phone:603-498-1113
Mailing Address - Fax:
Practice Address - Street 1:100 SHATTUCK WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-8004
Practice Address - Country:US
Practice Address - Phone:603-498-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter