Healthcare Provider Details

I. General information

NPI: 1639525207
Provider Name (Legal Business Name): ANNE E RUSHING MSN, MAC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 2ND ST
MELBA ID
83641-5199
US

IV. Provider business mailing address

211 16TH AVE N
NAMPA ID
83687-4058
US

V. Phone/Fax

Practice location:
  • Phone: 208-495-1011
  • Fax: 208-495-1012
Mailing address:
  • Phone: 208-461-7149
  • Fax: 208-467-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1061681
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number63831
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007208
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number590929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: