Provider Demographics
NPI:1518163864
Name:RUSH, JANE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:
Last Name:RUSH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 POPLAR ST
Mailing Address - Street 2:NMH BEHAVIORAL HEALTH SERVICES
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-2901
Mailing Address - Country:US
Mailing Address - Phone:860-354-3762
Mailing Address - Fax:860-350-2893
Practice Address - Street 1:23 POPLAR ST
Practice Address - Street 2:NMH BEHAVIORAL HEALTH SERVICES
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2901
Practice Address - Country:US
Practice Address - Phone:860-210-5350
Practice Address - Fax:860-210-5324
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001054363LF0000X
CT1054363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP79724Medicare UPIN