Provider Demographics
NPI:1386200236
Name:RUSSELL, CIE
Entity Type:Individual
Prefix:MRS
First Name:CIE
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FM 300
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-6235
Mailing Address - Country:US
Mailing Address - Phone:806-894-7842
Mailing Address - Fax:
Practice Address - Street 1:1000 FM 300
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-6235
Practice Address - Country:US
Practice Address - Phone:806-894-7842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140210363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP140210OtherTEXAS BOARD OF NURSING- PEDIATRIC NURSE PRACTITIONER LICENSURE
TX772532OtherTEXAS BOARD OF NURSING- RN LICENSURE