Provider Demographics
NPI:1134954464
Name:RUSH, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:RUSH
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 1:134 HIGHWAY Y
Mailing Address - Street 2:
Mailing Address - City:ALTENBURG
Mailing Address - State:MO
Mailing Address - Zip Code:63732-6129
Mailing Address - Country:US
Mailing Address - Phone:618-615-7831
Mailing Address - Fax:
Practice Address - Street 1:134 HIGHWAY Y
Practice Address - Street 2:
Practice Address - City:ALTENBURG
Practice Address - State:MO
Practice Address - Zip Code:63732-6129
Practice Address - Country:US
Practice Address - Phone:618-615-7831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019021417133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered