Provider Demographics
NPI:1184887549
Name:RUSH, MICHAELA D (MS, RD, CD)
Entity type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:D
Last Name:RUSH
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 220TH ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-4440
Mailing Address - Country:US
Mailing Address - Phone:425-482-4000
Mailing Address - Fax:425-482-4249
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:M/S CHC
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:425-482-4000
Practice Address - Fax:425-482-4249
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001987133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
850756OtherREGISTERED DIETITIAN
WADI00001987OtherDIETITIAN CERTIFICATION