1184887549 NPI number — MRS. MICHAELA D RUSH MS, RD, CD

Table of content: MS. CAROLYN LAVERNE BROWN (NPI 1811683139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184887549 NPI number — MRS. MICHAELA D RUSH MS, RD, CD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSH
Provider First Name:
MICHAELA
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, CD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184887549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 220TH ST SE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOTHELL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98021-4440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-482-4000
Provider Business Mailing Address Fax Number:
425-482-4249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 SAND POINT WAY NE
Provider Second Line Business Practice Location Address:
M/S CHC
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-482-4000
Provider Business Practice Location Address Fax Number:
425-482-4249
Provider Enumeration Date:
07/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1004X , with the licence number:  DI00001987 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 850756 . This is a "REGISTERED DIETITIAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: DI00001987 . This is a "DIETITIAN CERTIFICATION" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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