Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | G80238 | CA |
Y | 207Q00000X | Family Doctor | MD60545517 | WA |
N | 207QS0010X | Family Doctor - Sports Medicine | MD60545517 | WA |
NPI | 1144290586 |
---|---|
Provider Name | Shelby Renae Rush |
First Address | Spokane, WA 99201-0254 |
Second Address | Deer Park, WA 99006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 24/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G42330 | (02) |