Provider Demographics
NPI:1467975490
Name:PUST, JOANNA CLAIRE (TM)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:CLAIRE
Last Name:PUST
Suffix:
Gender:F
Credentials:TM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 COUNTY ROAD 6 NW
Mailing Address - Street 2:
Mailing Address - City:STANCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55080-8103
Mailing Address - Country:US
Mailing Address - Phone:763-898-0925
Mailing Address - Fax:
Practice Address - Street 1:1029 HIGHWAY 65 STE 109
Practice Address - Street 2:
Practice Address - City:BRAHAM
Practice Address - State:MN
Practice Address - Zip Code:55006-3359
Practice Address - Country:US
Practice Address - Phone:763-898-0925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife