Provider Demographics
NPI:1518209196
Name:RUSH, DEBORAH ANN (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:RUSH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 N CRESTMONT DR
Mailing Address - Street 2:STE A
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2177
Mailing Address - Country:US
Mailing Address - Phone:208-288-4200
Mailing Address - Fax:208-288-4279
Practice Address - Street 1:1550 N CRESTMONT DR
Practice Address - Street 2:SUITE E
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2184
Practice Address - Country:US
Practice Address - Phone:208-288-4200
Practice Address - Fax:208-288-4279
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1268A2084P0802X
IDNP1268A363LP0808X
IDN-25920163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID12644208OtherCAQH
ID1992858500Medicaid
ID1992858500Medicaid