Provider Demographics
NPI:1396967238
Name:RUSH, BRETT (APRN)
Entity type:Individual
Prefix:MR
First Name:BRETT
Middle Name:
Last Name:RUSH
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:903 W MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-0903
Mailing Address - Country:US
Mailing Address - Phone:201-358-0572
Mailing Address - Fax:210-358-5940
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:MCHE-QD
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-1399
Practice Address - Fax:210-916-1323
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121542367500000X
UT356507-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily