Healthcare Provider Details

I. General information

NPI: 1326916057
Provider Name (Legal Business Name): MARQUITA LATICE RUSH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 TOLER PL
NEWARK NJ
07114-1431
US

IV. Provider business mailing address

20 TOLER PL
NEWARK NJ
07114-1431
US

V. Phone/Fax

Practice location:
  • Phone: 973-329-0100
  • Fax:
Mailing address:
  • Phone: 973-329-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15562800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: