Provider Demographics
NPI:1215164066
Name:RUSK, CONNIE J (APRN)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:J
Last Name:RUSK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:J
Other - Last Name:HENDRIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:13112 SAINT PAUL DR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-2121
Mailing Address - Country:US
Mailing Address - Phone:303-503-6671
Mailing Address - Fax:303-839-7360
Practice Address - Street 1:13112 SAINT PAUL DR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-2121
Practice Address - Country:US
Practice Address - Phone:303-503-6671
Practice Address - Fax:303-839-7360
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77980363LN0005X, 363LN0000X
KS53-44709-091363LN0000X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal