Healthcare Provider Details

I. General information

NPI: 1841844172
Provider Name (Legal Business Name): DANIEL BRYAN RUST DNP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 E 2ND ST
CASPER WY
82609-4264
US

IV. Provider business mailing address

411 N FOREST DR UNIT 50752
CASPER WY
82605-0108
US

V. Phone/Fax

Practice location:
  • Phone: 307-232-6600
  • Fax:
Mailing address:
  • Phone: 520-628-0599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number234139-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28235362A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.452348
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number44308
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: