Healthcare Provider Details

I. General information

NPI: 1508096918
Provider Name (Legal Business Name): JILL ELIZABETH RUSHTON-MILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL ELIZABETH RUSHTON MD

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 AIRWAY DR
SANTA ROSA CA
95403-1670
US

IV. Provider business mailing address

451 AVIATION BLVD STE 100
SANTA ROSA CA
95403-9099
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-8887
  • Fax: 707-521-8820
Mailing address:
  • Phone: 707-521-8896
  • Fax: 707-546-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA122346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: