Healthcare Provider Details

I. General information

NPI: 1376514737
Provider Name (Legal Business Name): LINDA AMAIKWU RUSHING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 CHICAGO AVE
MINNEAPOLIS MN
55407-3570
US

IV. Provider business mailing address

8170 33RD AVE S
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-883-6805
  • Fax:
Mailing address:
  • Phone: 952-883-6805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3676
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: