MEDICARE: NERMINA RUSTEMPASIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385H00000X	Respite Care	BH4720	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BH4720	OTHER	AZ	AZ DEPT OF HEALTH SVCS

General Provider Information

NPI Number	:	1356716583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NERMINA RUSTEMPASIC

Provider Business Mailing Address
First Line	:	1301 E DEER CANYON RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-1094
Country	:	US
Telephone Number	:	520-307-9841
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 E DEER CANYON RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-1094
Country	:	US
Telephone Number	:	520-307-9841
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	12/14/2015

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Directions to “ NERMINA RUSTEMPASIC ” Practice Location

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