Provider Demographics
NPI:1033389507
Name:RUSSELL, SHIRLEY (APRN)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 BARIBEAU DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3230
Mailing Address - Country:US
Mailing Address - Phone:207-373-6923
Mailing Address - Fax:207-373-6959
Practice Address - Street 1:66 BARIBEAU DR
Practice Address - Street 2:SUITE 9
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3230
Practice Address - Country:US
Practice Address - Phone:207-373-6923
Practice Address - Fax:207-373-6959
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER024021163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult