Provider Demographics
NPI:1073838447
Name:JEAN-RUSH, JESSIE (MD)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:
Last Name:JEAN-RUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10909 W ALMERIA RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5413
Mailing Address - Country:US
Mailing Address - Phone:928-221-1185
Mailing Address - Fax:
Practice Address - Street 1:10909 W ALMERIA RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5413
Practice Address - Country:US
Practice Address - Phone:928-221-1185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24322208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics