Provider Demographics
NPI:1073277794
Name:HUGHES, RUSSEL DON (APRN, CNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:RUSSEL
Middle Name:DON
Last Name:HUGHES
Suffix:
Gender:M
Credentials:APRN, CNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 BURNING TREE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2634
Mailing Address - Country:US
Mailing Address - Phone:218-623-1803
Mailing Address - Fax:
Practice Address - Street 1:4720 BURNING TREE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2634
Practice Address - Country:US
Practice Address - Phone:218-623-1803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8718363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health