Provider Demographics
NPI:1114352937
Name:RUS, VASILE
Entity Type:Individual
Prefix:
First Name:VASILE
Middle Name:
Last Name:RUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19907 NE 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-6174
Mailing Address - Country:US
Mailing Address - Phone:360-723-0815
Mailing Address - Fax:360-723-0817
Practice Address - Street 1:19907 NE 104TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-6174
Practice Address - Country:US
Practice Address - Phone:360-723-0815
Practice Address - Fax:360-723-0817
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA750333171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor