Provider Demographics
NPI:1548986318
Name:KRUSH, ZACHARY PAUL (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:PAUL
Last Name:KRUSH
Suffix:
Gender:M
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 NE FAILING ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1058
Mailing Address - Country:US
Mailing Address - Phone:701-516-2065
Mailing Address - Fax:
Practice Address - Street 1:3653 SE 34TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3034
Practice Address - Country:US
Practice Address - Phone:503-988-5140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11806986-3102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily