Walter Mieczyslaw Rusin, MEDICAL STUDENT

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

4711 W Meadow Ave
Stillwater, OK 74074-1169

Phone

(612) 245-3813

NPI assigned

Nov 11, 2020

Last updated

Nov 11, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605052800000",
    "number": "1376145615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4711 W MEADOW AVE",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740741169",
            "telephone_number": "612-245-3813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 W MEADOW AVE",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740741169",
            "telephone_number": "612-245-3813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSIN",
        "first_name": "WALTER",
        "middle_name": "MIECZYSLAW",
        "credential": "MEDICAL STUDENT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-11",
        "last_updated": "2020-11-11",
        "certification_date": "2020-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katelynn Rothgeb
• Daniel Keith Roton, MD
• Elizabeth Rovick
• Lacy Anne Ruby, M.S.
• Darrin Lashae Rupp
• Russell C. Brorsen, D.D.S., P.L.L.C. (Brorsen Family Dental)
• Phillip G Russell, M.D.
• Kelly Ruth Sabers, ATC
• Darrell Lynn Sadler, DDS
• Sager Healthcare, PLLC

• Student in an Organized Health Care Education/Training Program in Stillwater, OK
• Providers in Stillwater, OK by specialty
• Student in an Organized Health Care Education/Training Program in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.