Provider Demographics
NPI:1609593433
Name:RUSK, COLLEEN JANIS (RN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:JANIS
Last Name:RUSK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 GREENWICH AVE APT E305
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1661
Mailing Address - Country:US
Mailing Address - Phone:860-287-2901
Mailing Address - Fax:
Practice Address - Street 1:307 GREENWICH AVE APT E305
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1661
Practice Address - Country:US
Practice Address - Phone:860-287-2901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN59017163WS0200X
MARN2322910163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WS0200XNursing Service ProvidersRegistered NurseSchool