=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710777040
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUSTIN N ATCHISON
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2025
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6800 NORMAL BLVD
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68506-6828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-742-0311
-----------------------------------------------------
Fax | 402-742-0312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 421 CAPITOL BEACH BLVD APT 13
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68528-1628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-525-3521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 372600000X
-----------------------------------------------------
Taxonomy Name | Adult Companion
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------