Healthcare Provider Details

I. General information

NPI: 1396143012
Provider Name (Legal Business Name): ELIZABETH RUSH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MUNICIPAL DR STE 200
FISHERS IN
46038-1634
US

IV. Provider business mailing address

14276 SERRA VISTA PT
FISHERS IN
46040-8123
US

V. Phone/Fax

Practice location:
  • Phone: 317-526-0107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28185004A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71005304A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: