Provider Demographics
NPI:1801923024
Name:RUSHING, HEATHER (MNT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:RUSHING
Suffix:
Gender:F
Credentials:MNT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:MATLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1731 FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-7113
Mailing Address - Country:US
Mailing Address - Phone:530-332-6840
Mailing Address - Fax:530-893-6858
Practice Address - Street 1:500 COHASSET RD STE 15
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2260
Practice Address - Country:US
Practice Address - Phone:530-433-2500
Practice Address - Fax:530-893-6858
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
CA810452133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27969ZMedicare ID - Type UnspecifiedPPIN
CAQ06040Medicare UPIN