Healthcare Provider Details

I. General information

NPI: 1730606583
Provider Name (Legal Business Name): LEANN R RUSHING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 95TH ST STE 105
NAPERVILLE IL
60564-7802
US

IV. Provider business mailing address

2007 95TH ST STE 105
NAPERVILLE IL
60564-7802
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-6920
  • Fax: 630-548-1749
Mailing address:
  • Phone: 630-646-6920
  • Fax: 630-548-1749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085006324
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: