Provider Demographics
NPI:1376831941
Name:RUSSELL, DEBRA MAE (ACNPC, CCRN-CSC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MAE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:ACNPC, CCRN-CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 THOMAS RD.
Mailing Address - Street 2:STE 107
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291
Mailing Address - Country:US
Mailing Address - Phone:318-329-8485
Mailing Address - Fax:
Practice Address - Street 1:102 THOMAS RD STE 104
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7365
Practice Address - Country:US
Practice Address - Phone:318-329-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06548363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care