Russell, Mary C

Russell, Mary C is an individual health care provider with primary practice located at 180 Emory Rd , Blaine TN 37709-2420. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Russell, Mary C can be contacted via phone (865) 933-4110.

Contact Information

Primary practice address
180 Emory Rd Blaine TN 37709-2420
Phone: (865) 933-4110
Fax: (865) 933-4729
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X RN65079 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X APN5921 Tennessee

Profile Details

NPI number 1447258652
LBN Legal business name Russell, Mary C
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2005
Last updated Jul 8th, 2007 - about 19 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 1447258652 NPPES
Tennessee MEDICAID 3342488

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