Provider Demographics
NPI:1366926008
Name:JOHNSON, RUSTIN BENDALL (RN)
Entity type:Individual
Prefix:
First Name:RUSTIN
Middle Name:BENDALL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:WOLF POINT
Mailing Address - State:MT
Mailing Address - Zip Code:59201-0729
Mailing Address - Country:US
Mailing Address - Phone:406-653-1641
Mailing Address - Fax:406-653-3728
Practice Address - Street 1:550 6TH AVE N
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-6000
Practice Address - Country:US
Practice Address - Phone:406-653-1641
Practice Address - Fax:406-653-3728
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-148876163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-148876OtherALABAMA BOARD OF NURSING