Provider Demographics
NPI:1922521905
Name:RUSHTON, KIERA LATITIA
Entity Type:Individual
Prefix:
First Name:KIERA
Middle Name:LATITIA
Last Name:RUSHTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 PINECREST ST APT 7
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1387
Mailing Address - Country:US
Mailing Address - Phone:989-255-0620
Mailing Address - Fax:
Practice Address - Street 1:539 PINECREST ST APT 2
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1386
Practice Address - Country:US
Practice Address - Phone:989-356-6050
Practice Address - Fax:989-356-6050
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIR235469488328372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider