Russell, John Calvin

Russell, John Calvin is an individual health care provider with primary practice located at 2201 N Broadwell Ave , Grand Island NE 68803-2153. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Russell, John Calvin can be contacted via phone (308) 382-3660.

Contact Information

Primary practice address
2201 N Broadwell Ave Grand Island NE 68803-2153
Fax: (308) 395-3214
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 815 Nebraska

Profile Details

NPI number 1275584070
LBN Legal business name Russell, John Calvin
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date May 15th, 2006
Last updated Apr 25th, 2017 - about 8 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275584070 NPPES
Nebraska MEDICAID 47078557539

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