Healthcare Provider Details

I. General information

NPI: 1821702341
Provider Name (Legal Business Name): SHERYL RUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WESTWOOD DR APT 2B
MARRERO LA
70072-4500
US

IV. Provider business mailing address

8326 KELWOOD AVE
BATON ROUGE LA
70806-4803
US

V. Phone/Fax

Practice location:
  • Phone: 504-782-8478
  • Fax:
Mailing address:
  • Phone: 318-459-6795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: