Provider Demographics
NPI:1538451372
Name:RUST, JOHN WILLIAM (NP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:RUST
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WILSON CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:LAWENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025
Mailing Address - Country:US
Mailing Address - Phone:812-537-1010
Mailing Address - Fax:812-537-2897
Practice Address - Street 1:600 WILSON CREEK ROAD
Practice Address - Street 2:
Practice Address - City:LAWENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025
Practice Address - Country:US
Practice Address - Phone:812-537-1010
Practice Address - Fax:812-537-2897
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28155083A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily