Provider Demographics
NPI:1952343105
Name:RUST, NANCY E (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:E
Last Name:RUST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 LABREE AVE N
Mailing Address - Street 2:PO BOX 12
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-2022
Mailing Address - Country:US
Mailing Address - Phone:218-681-2718
Mailing Address - Fax:
Practice Address - Street 1:213 LABREE AVE N
Practice Address - Street 2:SUITE 104
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-2022
Practice Address - Country:US
Practice Address - Phone:218-681-2718
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1285103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN76104OtherHEALTH PARTNERS
MN848081028193OtherPREFERRED ONE
MN4H963RUOtherBLUE CROSS
NYA947005OtherVALUE OPTIONS
MN1041350OtherCIGNA BEHAVORIAL HEALTH
NDRUS12429OtherBLUE CROSS