Healthcare Provider Details

I. General information

NPI: 1831449628
Provider Name (Legal Business Name): ARLENE RUSH DE BURGOS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 GARDEN OF THE GODS RD STE 2044
COLORADO SPRINGS CO
80907-9444
US

IV. Provider business mailing address

1675 GARDEN OF THE GODS RD
COLORADO SPRINGS CO
80907-9444
US

V. Phone/Fax

Practice location:
  • Phone: 719-578-3232
  • Fax:
Mailing address:
  • Phone: 719-578-3199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0067492
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: