Individual
KELLIE JEAN RUSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
671 VANDALIA ST, SAINT PAUL, MN 55114-1312
(651) 698-2406
Mailing address
4227 UPTON AVE N, MINNEAPOLIS, MN 55412-1523
(612) 799-4660
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1747508
MN
363LF0000X
Family Nurse Practitioner
Primary
6976
MN
Other
Enumeration date
08/25/2020
Last updated
08/25/2020
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