Healthcare Provider Details

I. General information

NPI: 1104975549
Provider Name (Legal Business Name): AMY J RUSHTON APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MONROE ST
ROCKVILLE MD
20850
US

IV. Provider business mailing address

208 MONROE ST
ROCKVILLE MD
20850
US

V. Phone/Fax

Practice location:
  • Phone: 301-309-8200
  • Fax: 301-309-9667
Mailing address:
  • Phone: 301-309-8200
  • Fax: 301-309-9667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAC000210
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number0015000797
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: