Individual
DR. KEONDRA MARTINIQUE RUSTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-DNP, PH.D
Contact information
Practice address
1600 S LANE ST, SEATTLE, WA 98144-2810
(206) 682-2371
Mailing address
3116 164TH ST SW APT 1406, LYNNWOOD, WA 98087-3250
(760) 895-5514
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
ARNP.AP.70007587-NP
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/29/2022
Last updated
08/18/2025
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