Jacqueline Anne Rust, APRN, BC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

R-120354-7 Issued in MN

Practice address

1 Veterans Dr
111J
Minneapolis, MN 55417-2309

Phone

(612) 467-3218

Fax

(612) 727-5640

NPI assigned

Sep 25, 2006

Last updated

Jul 21, 2022By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1942300025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3180 JURDY CT N",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551212105",
            "telephone_number": "651-452-6733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 VETERANS DR",
            "address_2": "111J",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554172309",
            "telephone_number": "612-467-3218",
            "fax_number": "612-727-5640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUST",
        "first_name": "JACQUELINE",
        "middle_name": "ANNE",
        "credential": "APRN, BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "R-120354-7",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evelyn Ruth Russell, PT
• Holly Ann Russell, RD
• Naijia Russell
• Sarah Russell
• Shane Russell, LICSW
• Sarah Rust
• John Libakken Rustad, MD
• Amber Joell Ruth, LICSW
• Camellia Rutten
• Anastasia Irina Rutz

• Gerontology Nurse Practitioner in Minneapolis, MN
• Providers in Minneapolis, 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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.