Provider Demographics
NPI:1508205477
Name:DUSTIN, IRENE (CRNP)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:DUSTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NIH NINDS CES BLDG 10 7 5644
Mailing Address - Street 2:10 CENTER DRIVE
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-1408
Mailing Address - Country:US
Mailing Address - Phone:301-451-9284
Mailing Address - Fax:
Practice Address - Street 1:NIH NINDS CES BLDG 10 7 5644
Practice Address - Street 2:10 CENTER DRIVE
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-1408
Practice Address - Country:US
Practice Address - Phone:301-451-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114723363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology