Russell, Mary Jo

Russell, Mary Jo is an individual health care provider with primary practice located at 2300 53Rd Ave Suite 100, Bettendorf IA 52722-7564. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Russell, Mary Jo can be contacted via phone (563) 322-0971.

Contact Information

Primary practice address
2300 53Rd Ave Suite 100 Bettendorf IA 52722-7564
Phone: (563) 322-0971
Fax: (563) 324-0615
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 001347 Iowa

Profile Details

NPI number 1528046695
LBN Legal business name Russell, Mary Jo
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 9th, 2006
Last updated Nov 8th, 2013 - about 13 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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