Provider Demographics
NPI:1376794446
Name:RUSSELL, SUZANNE RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:RENEE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13075 W MCDOWELL STE D106
Mailing Address - Street 2:NEXTCARE URGENT CARE
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323
Mailing Address - Country:US
Mailing Address - Phone:623-536-9576
Mailing Address - Fax:
Practice Address - Street 1:13075 W MCDOWELL STE D106
Practice Address - Street 2:NEXTCARE URGENT CARE
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323
Practice Address - Country:US
Practice Address - Phone:623-536-9576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4220363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical