Provider Demographics
NPI:1235266222
Name:RUSS, DANA L (NP MSN)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:L
Last Name:RUSS
Suffix:
Gender:F
Credentials:NP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 POTRERO AVE # 5M
Mailing Address - Street 2:WOMEN'S CLINIC
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-5483
Mailing Address - Fax:415-206-4562
Practice Address - Street 1:1001 POTRERO AVE # 5M
Practice Address - Street 2:WOMEN'S CLINIC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-5483
Practice Address - Fax:415-206-4562
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN552449163WW0101X
CANPF13621363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
101295OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
Q24102Medicare UPIN