Provider Demographics
NPI:1447967807
Name:RUSK, NIKITA (COSMETOLOGIST)
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:RUSK
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 W DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-5030
Mailing Address - Country:US
Mailing Address - Phone:469-785-1117
Mailing Address - Fax:
Practice Address - Street 1:1009 W DAVIS ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5030
Practice Address - Country:US
Practice Address - Phone:469-785-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty