Provider Demographics
NPI:1174083349
Name:RUSH, STACI ELIZABETH (RN)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:ELIZABETH
Last Name:RUSH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:ELIZABETH
Other - Last Name:OVERSTREET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 UNION SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2084
Mailing Address - Country:US
Mailing Address - Phone:615-206-1100
Mailing Address - Fax:615-206-9448
Practice Address - Street 1:1005 UNION SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2084
Practice Address - Country:US
Practice Address - Phone:615-206-1100
Practice Address - Fax:615-206-9448
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000196004163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health