Provider Demographics
NPI:1154160794
Name:NYSTROM, DUSTI L
Entity type:Individual
Prefix:
First Name:DUSTI
Middle Name:L
Last Name:NYSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCKFORD
Mailing Address - State:ND
Mailing Address - Zip Code:58356-1826
Mailing Address - Country:US
Mailing Address - Phone:701-302-0044
Mailing Address - Fax:
Practice Address - Street 1:231 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCKFORD
Practice Address - State:ND
Practice Address - Zip Code:58356-1826
Practice Address - Country:US
Practice Address - Phone:701-302-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR35398163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice