Russell, Debra G
Russell, Debra G is an sole proprietor health care provider with primary practice located at 225 Physicians Park Ste 203 , Poplar Bluff MO 63901-3921. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Russell, Debra G can be contacted via phone (573) 686-4750.Contact Information
Primary practice address
225 Physicians Park Ste 203
Poplar Bluff MO 63901-3921
Phone: (573) 686-4750
Fax: (573) 686-4753
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | MO076908 | Missouri |
Profile Details
| NPI number | 1255304440 |
|---|---|
| LBN Legal business name | Russell, Debra G |
| Credentials | Family Nurse Practitioner (FNP) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 9th, 2006 |
| Last updated | Aug 31st, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255304440 | NPPES |
| Missouri | MEDICAID | 425335809 |
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