Provider Demographics
NPI:1679919559
Name:RUSHIN, BONNIE MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:MARIE
Last Name:RUSHIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 N HALSTED ST
Mailing Address - Street 2:STE 501
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2605
Mailing Address - Country:US
Mailing Address - Phone:773-388-6390
Mailing Address - Fax:312-867-7101
Practice Address - Street 1:1460 N HALSTED ST
Practice Address - Street 2:STE 501
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2605
Practice Address - Country:US
Practice Address - Phone:773-388-6390
Practice Address - Fax:312-867-7101
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004631363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant