Provider Demographics
NPI:1235282872
Name:RUSIN, WENDY MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MARIE
Last Name:RUSIN
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 1:2907 W MIDWEST DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-2556
Mailing Address - Country:US
Mailing Address - Phone:801-955-4904
Mailing Address - Fax:
Practice Address - Street 1:2907 W MIDWEST DR
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2556
Practice Address - Country:US
Practice Address - Phone:801-898-1754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4757258-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner