Provider Demographics
NPI:1427696475
Name:RUSH, PORSCHA (NP)
Entity type:Individual
Prefix:
First Name:PORSCHA
Middle Name:
Last Name:RUSH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 FRYE RD
Mailing Address - Street 2:
Mailing Address - City:GALIVANTS FERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29544-8018
Mailing Address - Country:US
Mailing Address - Phone:843-360-3225
Mailing Address - Fax:
Practice Address - Street 1:1040 FRYE RD
Practice Address - Street 2:
Practice Address - City:GALIVANTS FERRY
Practice Address - State:SC
Practice Address - Zip Code:29544-8018
Practice Address - Country:US
Practice Address - Phone:843-360-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23506363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health