Doctor Name: | MRS. GEORGIA RUSSELL |
NPI Number: | 1073785408 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 209410-4405 |
Business Practice Address: | 719 West 400 North Moab, UT - 84532 |
Business Phone Number: | 4352597191 |
Business Fax Number: | |
Mailing Address: | 719 West 400 North, MOAB |
State: | UT |
Postal Code: | 84532 |
Phone Number: | 4352597191 |
Fax Number: | |
NPI Enumeration Date: | 03/26/2008 |
NPI Last Update Date: | 03/26/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209410-4405 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |