Provider Demographics
NPI:1821043548
Name:DUSTIN, CURT RYDELL (MSN, APRN, BC)
Entity Type:Individual
Prefix:MR
First Name:CURT
Middle Name:RYDELL
Last Name:DUSTIN
Suffix:
Gender:M
Credentials:MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 E 2000 N
Mailing Address - Street 2:STE 104
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9335
Mailing Address - Country:US
Mailing Address - Phone:435-882-1644
Mailing Address - Fax:435-882-4098
Practice Address - Street 1:576 E HIGHWAY 138 STE 400
Practice Address - Street 2:
Practice Address - City:STANSBURY PARK
Practice Address - State:UT
Practice Address - Zip Code:84074-4028
Practice Address - Country:US
Practice Address - Phone:435-843-1342
Practice Address - Fax:435-843-1343
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT264218-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0926381Medicaid
UT005589903Medicare ID - Type UnspecifiedMEDICARE
UT0926381Medicaid