Healthcare Provider Details

I. General information

NPI: 1821555160
Provider Name (Legal Business Name): ANGELA PERROU RUTHERFORD MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 CREEKSTONE DR STE 300
DURHAM NC
27703-0016
US

IV. Provider business mailing address

8220 ORTIN LN
RALEIGH NC
27612-7240
US

V. Phone/Fax

Practice location:
  • Phone: 919-385-7877
  • Fax: 919-576-8806
Mailing address:
  • Phone: 919-622-9409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberL001920
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: