Provider Demographics
NPI:1407725088
Name:RUSTIN, JENNIFER C (RN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:C
Last Name:RUSTIN
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 271
Mailing Address - Street 2:
Mailing Address - City:KIRKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46050-0271
Mailing Address - Country:US
Mailing Address - Phone:317-840-3697
Mailing Address - Fax:
Practice Address - Street 1:307 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KIRKLIN
Practice Address - State:IN
Practice Address - Zip Code:46050-9735
Practice Address - Country:US
Practice Address - Phone:317-840-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28205652A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty