Provider Demographics
NPI:1790854826
Name:RUSH, CANDI MARIE (LPN)
Entity type:Individual
Prefix:MISS
First Name:CANDI
Middle Name:MARIE
Last Name:RUSH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:CANDI
Other - Middle Name:MARIE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:REA CLINIC
Mailing Address - Street 2:PO BOX 155
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-2571
Practice Address - Street 1:REA CLINIC
Practice Address - Street 2:4241 HWY 14 WEST
Practice Address - City:CHRISTOPHER
Practice Address - State:IL
Practice Address - Zip Code:62822
Practice Address - Country:US
Practice Address - Phone:618-724-2401
Practice Address - Fax:618-724-2571
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse