Provider Demographics
NPI:1427373190
Name:RUSHBY, VICKI LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:RUSHBY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:RAYMOND WRIGHT AVE.
Mailing Address - City:WITHERBEE
Mailing Address - State:NY
Mailing Address - Zip Code:12998-0045
Mailing Address - Country:US
Mailing Address - Phone:518-942-7088
Mailing Address - Fax:
Practice Address - Street 1:3384 FISHER HILL ROAD
Practice Address - Street 2:APARTMENT 1
Practice Address - City:MINEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12956
Practice Address - Country:US
Practice Address - Phone:518-546-3218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10 261852164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse