Provider Demographics
NPI:1144803503
Name:RUSH, TANEKA
Entity Type:Individual
Prefix:
First Name:TANEKA
Middle Name:
Last Name:RUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 PAW PAW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:WV
Mailing Address - Zip Code:26570-9336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:252 PAW PAW CREEK RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:WV
Practice Address - Zip Code:26570-9336
Practice Address - Country:US
Practice Address - Phone:304-841-5978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant