Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | WE HAVE NO NUMBER | OR |
NPI | 1316212095 |
---|---|
Provider Name | Dustin Rushing |
First Address | Vancouver, WA 98663-3211 |
Second Address | Clackamas, OR 97015-8969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2012 |
Last Update Date | 14/03/2012 |