Provider Demographics
NPI:1730332974
Name:RUSH, MICHELLE ANNALOU (CERTIFIED NURSE ASST)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:ANNALOU
Last Name:RUSH
Suffix:
Gender:F
Credentials:CERTIFIED NURSE ASST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 242
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-2850
Mailing Address - Country:US
Mailing Address - Phone:708-368-7482
Mailing Address - Fax:
Practice Address - Street 1:14507 PULASKI RD APT 1
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-2850
Practice Address - Country:US
Practice Address - Phone:708-368-7482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376K00000XNursing Service Related ProvidersNurse's Aide