Provider Demographics
NPI:1124508221
Name:KUST, DENISE (RNFA)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:KUST
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16298 SW BURNTWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-4870
Mailing Address - Country:US
Mailing Address - Phone:503-799-0984
Mailing Address - Fax:
Practice Address - Street 1:16298 SW BURNTWOOD WAY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-4870
Practice Address - Country:US
Practice Address - Phone:503-799-0984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201404454RN163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery