Rustad, Debra Ann

Rustad, Debra Ann is an sole proprietor health care provider with primary practice located at 3850 Park Nicollet Blvd Park Nicollet Clinic--Senior Services-- 3Rd Floor, St Louis Park MN 55416-2527. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Gerontology, which is considered as her primary health care specialty. Rustad, Debra Ann can be contacted via phone (952) 993-5041.

Contact Information

Primary practice address
3850 Park Nicollet Blvd Park Nicollet Clinic--Senior Services-- 3Rd Floor St Louis Park MN 55416-2527
Phone: (952) 993-5041
Fax: (952) 993-3236
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X R092748-4 Minnesota

Profile Details

NPI number 1487659587
LBN Legal business name Rustad, Debra Ann
Credentials RN, CNP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 15th, 2005
Last updated Mar 18th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487659587 NPPES
Minnesota MEDICAID 090529100

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