Provider Demographics
NPI:1174389035
Name:ANDERSON, DUSTI (BSN RN)
Entity type:Individual
Prefix:
First Name:DUSTI
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:DUSTI
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN RN
Mailing Address - Street 1:5319 WESTON AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-1909
Mailing Address - Country:US
Mailing Address - Phone:208-740-9808
Mailing Address - Fax:
Practice Address - Street 1:417 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7632
Practice Address - Country:US
Practice Address - Phone:208-740-9808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID72843163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice