Provider Demographics
NPI:1285499392
Name:MASHBURN, DUSTIN RAY (APRN)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:RAY
Last Name:MASHBURN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 MARKET ST UNIT 112
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6671
Mailing Address - Country:US
Mailing Address - Phone:603-266-8071
Mailing Address - Fax:
Practice Address - Street 1:198 N MAIN ST STE C-3
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3020
Practice Address - Country:US
Practice Address - Phone:802-770-1814
Practice Address - Fax:802-636-6285
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0136925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily