| Doctor Name: | LISA DAWN RUSSELL |
| NPI Number: | 1730514316 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 28101863A |
| Business Practice Address: | 1343 County Road 1450 E Carmi, IL - 628215205 |
| Business Phone Number: | 6183822103 |
| Business Fax Number: | |
| Mailing Address: | 18033 County Road 500 E, DAHLGREN |
| State: | IL |
| Postal Code: | 628284294 |
| Phone Number: | 6186482668 |
| Fax Number: | |
| NPI Enumeration Date: | 09/13/2013 |
| NPI Last Update Date: | 02/29/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 28101863A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |