Individual
DEBRA ANN RUSTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CNP
Contact information
Practice address
3850 PARK NICOLLET BLVD, PARK NICOLLET CLINIC--SENIOR SERVICES-- 3RD FLOOR, ST LOUIS PARK, MN 55416-2527
(952) 993-5041
(952) 993-3236
Mailing address
8170 33RD AVE S # MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
R092748-4
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
090529100
—
MN
Enumeration date
06/15/2005
Last updated
03/18/2021
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