Provider Demographics
NPI:1225179435
Name:RUSSELL, ROBIN LYNN (ND)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:LYNN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:PINE MEADOW
Mailing Address - State:CT
Mailing Address - Zip Code:06061-0046
Mailing Address - Country:US
Mailing Address - Phone:860-909-1082
Mailing Address - Fax:860-379-0876
Practice Address - Street 1:280 MAIN ST # C
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06057-2748
Practice Address - Country:US
Practice Address - Phone:860-909-1082
Practice Address - Fax:860-379-0876
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001421175F00000X
CT000491175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath