Provider Demographics
NPI:1417233057
Name:RUST, STACY IRENE (RN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:IRENE
Last Name:RUST
Suffix:
Gender:F
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 457
Mailing Address - Street 2:
Mailing Address - City:MCDERMITT
Mailing Address - State:NV
Mailing Address - Zip Code:89421-0457
Mailing Address - Country:US
Mailing Address - Phone:775-532-8522
Mailing Address - Fax:
Practice Address - Street 1:112 NORTH RESERVATION ROAD
Practice Address - Street 2:
Practice Address - City:MCDERMITT
Practice Address - State:NV
Practice Address - Zip Code:89421-0457
Practice Address - Country:US
Practice Address - Phone:775-532-8522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN62644163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse