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General NPI Number Information
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NPI Number | 1518024850
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Entity Type | Individual
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Provider Name | SANDRA JANE RUSTON APNP
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 910 FREMONT ST UWSP HEALTH SERVICE
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City | STEVENS POINT
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State | WI
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Zip | 54481-3105
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Country | US
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Telephone | 715-346-4304
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Fax |
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Provider Business Mailing Address
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Address Line | 1405 LAKE DR
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City | ROSHOLT
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State | WI
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Zip | 54473-9164
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Country | US
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Telephone | 715-446-2508
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 156
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License Number State | WI
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