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
Phone: (308) 382-3660
Fax: (308) 395-3214
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275584070 | NPPES |
| Nebraska | MEDICAID | 47078557539 |
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