Russell, Nicole E

Russell, Nicole E is an individual health care provider with primary practice located at 5496 E Taft Rd , North Syracuse NY 13212-3784. 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, Nicole E can be contacted via phone (315) 552-6700.

Contact Information

Primary practice address
5496 E Taft Rd North Syracuse NY 13212-3784
Phone: (315) 552-6700
Fax: (315) 552-6701
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 337402 New York

Profile Details

NPI number 1366795551
LBN Legal business name Russell, Nicole E
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 25th, 2012
Last updated Feb 8th, 2021 - about 3 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 1366795551 NPPES
New York MEDICAID 03519028

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