Provider Demographics
NPI:1841844172
Name:RUST, DANIEL BRYAN (DNP, CRNA)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BRYAN
Last Name:RUST
Suffix:
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:411 N FOREST DR UNIT 50752
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605-0108
Mailing Address - Country:US
Mailing Address - Phone:520-628-0599
Mailing Address - Fax:
Practice Address - Street 1:6350 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4264
Practice Address - Country:US
Practice Address - Phone:307-232-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI234139-30163W00000X
IN28235362A163W00000X
IL041.452348163W00000X
WY44308367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse