Russum, Jennifer

Russum, Jennifer is an individual health care provider with primary practice located at 732 Clinton Pkwy , Clinton MS 39056-5227. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Russum, Jennifer can be contacted via phone (601) 924-7994.

Contact Information

Primary practice address
732 Clinton Pkwy Clinton MS 39056-5227
Phone: (601) 924-7994
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X R880745 Mississippi

Profile Details

NPI number 1376951921
LBN Legal business name Russum, Jennifer
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 28th, 2014
Last updated Sep 10th, 2020 - about 4 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 1376951921 NPPES
Mississippi MEDICAID 01633507

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