Provider Demographics
NPI:1346780368
Name:RUSH, NADEZHDA
Entity Type:Individual
Prefix:MRS
First Name:NADEZHDA
Middle Name:
Last Name:RUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NADEZHDA
Other - Middle Name:
Other - Last Name:TSERADZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1375 E 18TH ST APT E4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1375 E 18TH ST APT E4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7525
Practice Address - Country:US
Practice Address - Phone:914-562-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY579918-1163W00000X
NYF342620-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse