Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 53-44709-091 | KS |
N | 363LN0000X | Nurse Practitioner - Neonatal | 77980 | CO |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 53-44709-091 | KS |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 77980 | CO |
NPI | 1215164066 |
---|---|
Provider Name | Connie J Rusk |
First Address | Thornton, CO 80241-2121 |
Second Address | Thornton, CO 80241-2121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2009 |
Last Update Date | 15/11/2014 |