Basic Information
| Provider Information | |||||||||
| NPI: | 1336739267 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSH | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 CLEMENT WAY | ||||||||
| Address2: | |||||||||
| City: | BELGRADE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049174370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074953323 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4 CLEMENT WAY | ||||||||
| Address2: | |||||||||
| City: | BELGRADE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049174370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074953323 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2021 | ||||||||
| LastUpdateDate: | 09/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | RN66641 | ME | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | CNP211003 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.