| Doctor Name: | MS. SHANNON R RUSSOM |
| NPI Number: | 1013948850 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 1010017858 |
| Business Practice Address: | 353 Blair Park Rd Williston, VT - 054957530 |
| Business Phone Number: | 8028471600 |
| Business Fax Number: | 8028477184 |
| Mailing Address: | 87 Carse Rd, HUNTINGTON |
| State: | VT |
| Postal Code: | 054629550 |
| Phone Number: | 8024344195 |
| Fax Number: | |
| NPI Enumeration Date: | 07/06/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 1010017858 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |