Provider Demographics
NPI:1518024850
Name:RUSTON, SANDRA JANE (APNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JANE
Last Name:RUSTON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ROSHOLT
Mailing Address - State:WI
Mailing Address - Zip Code:54473-9164
Mailing Address - Country:US
Mailing Address - Phone:715-446-2508
Mailing Address - Fax:
Practice Address - Street 1:910 FREMONT ST
Practice Address - Street 2:UWSP HEALTH SERVICE
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3105
Practice Address - Country:US
Practice Address - Phone:715-346-4304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI156363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner