Provider Demographics
NPI:1376277871
Name:RUST, HALEY
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:RUST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 ELM ST
Mailing Address - Street 2:
Mailing Address - City:TABOR
Mailing Address - State:IA
Mailing Address - Zip Code:51653-2090
Mailing Address - Country:US
Mailing Address - Phone:417-987-9076
Mailing Address - Fax:
Practice Address - Street 1:981090 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-1090
Practice Address - Country:US
Practice Address - Phone:417-987-9076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist