Russell, Shelley W
Russell, Shelley W is an individual health care provider with primary practice located at 2425 Dave Ward Dr Suite 202, Conway AR 72034-8686. She recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as her primary health care specialty. Russell, Shelley W can be contacted via phone (501) 328-5050.Contact Information
Primary practice address
2425 Dave Ward Dr Suite 202
Conway AR 72034-8686
Phone: (501) 328-5050
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | E1574 | Arkansas |
Profile Details
| NPI number | 1457330011 |
|---|---|
| LBN Legal business name | Russell, Shelley W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 12th, 2006 |
| Last updated | Nov 9th, 2010 - about 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1457330011 | NPPES |
| Arkansas | MEDICAID | 140525001 |
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