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Individual

MARIVIC RUSTIA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2222 NW LOVEJOY ST STE 411, PORTLAND, OR 97210-5102
(503) 413-5598
Mailing address
255 SW HARRISON ST APT 11D, PORTLAND, OR 97201-5387
(682) 240-5523

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
AP139794
TX

Other

Enumeration date
11/21/2018
Last updated
10/12/2021
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