Provider Demographics
NPI:1124387477
Name:RUSSELL, ANNE MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MARIE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 BLUE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-1802
Mailing Address - Country:US
Mailing Address - Phone:608-886-0288
Mailing Address - Fax:
Practice Address - Street 1:1550 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:PLAIN
Practice Address - State:WI
Practice Address - Zip Code:53577-9644
Practice Address - Country:US
Practice Address - Phone:608-546-9834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30536-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse