Russell, Mark L

Russell, Mark L is an individual health care provider with primary practice located at 125 Lasalle Rd , West Hartford CT 06107-2322. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as his primary health care specialty. Russell, Mark L can be contacted via phone (860) 906-1289.

Contact Information

Primary practice address
125 Lasalle Rd West Hartford CT 06107-2322
Phone: (860) 906-1289
Fax: (860) 906-1269
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 077986 Connecticut

Profile Details

NPI number 1609164532
LBN Legal business name Russell, Mark L
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2011
Last updated Jun 4th, 2015 - about 9 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 1609164532 NPPES
Connecticut Other 077986 LICENSE

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