Healthcare Provider Details

I. General information

NPI: 1114847878
Provider Name (Legal Business Name): ELIZABETH RUST
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

20400 POPLAR CREEK PKWY UNIT 417
BROOKFIELD WI
53045-2243
US

V. Phone/Fax

Practice location:
  • Phone: 262-909-4928
  • Fax:
Mailing address:
  • Phone: 262-909-4928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number261426-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: