Provider Demographics
NPI:1467901165
Name:RUSH, HANNAH GRACE (CRNP)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:GRACE
Last Name:RUSH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-4002
Mailing Address - Country:US
Mailing Address - Phone:718-483-9871
Mailing Address - Fax:718-771-3174
Practice Address - Street 1:2050 DEAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-4002
Practice Address - Country:US
Practice Address - Phone:718-483-9871
Practice Address - Fax:718-771-3174
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-138569363LP0808X
NY342433363LP2300X
NY402336363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05034006Medicaid