Provider Demographics
NPI:1225544380
Name:RUSSELL, ANDREA MARY (RN2)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARY
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:RN2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E AND WEST RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3602
Mailing Address - Country:US
Mailing Address - Phone:716-677-7000
Mailing Address - Fax:716-677-7072
Practice Address - Street 1:1010 E AND WEST RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3602
Practice Address - Country:US
Practice Address - Phone:716-677-7000
Practice Address - Fax:716-677-7072
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303679163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent