Provider Demographics
NPI:1598993925
Name:RUSCH, REBECCA R (NP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:R
Last Name:RUSCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:R
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:13950 W. W. CAPITOL DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2441
Mailing Address - Country:US
Mailing Address - Phone:262-781-3065
Mailing Address - Fax:262-781-3835
Practice Address - Street 1:13950 W. W. CAPITOL DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2441
Practice Address - Country:US
Practice Address - Phone:262-781-3065
Practice Address - Fax:262-781-3835
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3783-33363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1598993925Medicaid
WI736011524Medicare PIN