Provider Demographics
NPI:1023284742
Name:RUSTAD, JANIS D (FNP)
Entity type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:D
Last Name:RUSTAD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8752 E VIA DE COMMERCIO
Mailing Address - Street 2:STE 2
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3396
Mailing Address - Country:US
Mailing Address - Phone:480-425-8700
Mailing Address - Fax:480-425-8701
Practice Address - Street 1:8752 E VIA DE COMMERCIO STE 2
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3396
Practice Address - Country:US
Practice Address - Phone:480-425-8700
Practice Address - Fax:480-425-8701
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily