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General NPI Number Information
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NPI Number | 1841972205
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Entity Type | Individual
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Provider Name | JORDAIN RUTHERFORD PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 2509 W MARCH LN STE 250
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City | STOCKTON
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State | CA
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Zip | 95207-8222
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Country | US
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Telephone | 209-290-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 2509 W MARCH LN STE 250
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City | STOCKTON
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State | CA
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Zip | 95207-8222
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Country | US
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Telephone | 209-290-1700
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Fax | 209-290-3633
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95014277
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License Number State | CA
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