Provider Demographics
NPI:1992251268
Name:RUST, SANDRA DOLLENE (APRN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:DOLLENE
Last Name:RUST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 W 100 N STE 6
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2026
Mailing Address - Country:US
Mailing Address - Phone:435-789-0064
Mailing Address - Fax:435-789-0537
Practice Address - Street 1:266 W 100 N STE 6
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2026
Practice Address - Country:US
Practice Address - Phone:435-789-0064
Practice Address - Fax:435-789-0537
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5180478-8900363LF0000X
UT5180478-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily