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NPI Code Detail

MEDICARE: JEAN LAUREL RUSH NP-C

MEDICARE: JEAN LAUREL RUSH NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner209-003893IL

General Provider Information

NPI Number : 1821093238
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEAN LAUREL RUSH NP-C
Provider Business Mailing Address
First Line : 1061 HARMON AVE
Second Line :
City : FORT STEWART
State : GA
Zip : 31314-5641
Country : US
Telephone Number : 708-337-0487
Fax Number :
Provider Business Practice Location Address
First Line : 1061 HARMON AVE
Second Line :
City : FORT STEWART
State : GA
Zip : 31314-5641
Country : US
Telephone Number : 708-337-0487
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 12/16/2014

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Directions to “ JEAN LAUREL RUSH NP-C” Practice Location

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