Provider Demographics
NPI:1851622849
Name:RUSH, JESSICA LOUANN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LOUANN
Last Name:RUSH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4057
Mailing Address - Country:US
Mailing Address - Phone:620-687-2424
Mailing Address - Fax:
Practice Address - Street 1:3522 NORMAN DR
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4057
Practice Address - Country:US
Practice Address - Phone:620-687-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010001472367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered