Provider Demographics
NPI:1033980511
Name:RUSH, ERIC W (APRN-CNP)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:W
Last Name:RUSH
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 E REPUBLICAN ST APT 303
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4788
Mailing Address - Country:US
Mailing Address - Phone:513-720-7969
Mailing Address - Fax:
Practice Address - Street 1:1800 112TH AVE NE STE 220W
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2964
Practice Address - Country:US
Practice Address - Phone:509-465-1252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.518828163W00000X
OHAPRN.CNP.0036839363LP0808X
ID9071647363LP0808X
WAAP61611190363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse