Debra Ann Rustad, RN, CNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

R092748-4 Issued in MN

Practice address

3850 Park Nicollet Blvd
Park Nicollet Clinic--Senior Services-- 3Rd Floor
St Louis Park, MN 55416-2527

Phone

(952) 993-5041

Fax

(952) 993-3236

NPI assigned

Jun 15, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Evercare Collaborative Solutions Inc

  • Registered Nurse
  • Minnetonka, MN
  • NPI 1285686378
  NPD (past)

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1487659587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 PARK NICOLLET BLVD",
            "address_2": "PARK NICOLLET CLINIC--SENIOR SERVICES-- 3RD FLOOR",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162527",
            "telephone_number": "952-993-5041",
            "fax_number": "952-993-3236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSTAD",
        "first_name": "DEBRA",
        "middle_name": "ANN",
        "credential": "RN, CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-15",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "R092748-4",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "090529100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaiya Ruff, MA, LPCC
• Hallie Ruhl
• Lu Ann Runkle, OPA
• Tova Rupp
• Colleen Russell, RN
• Shirley M. Rutherford, M.A., LP
• Beverly A Rutledge, WHCNP
• Kirsten R Ryan, PT
• Maggie Ryan
• Megan Ryan

• Gerontology Nurse Practitioner in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Gerontology Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; 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.