Provider Demographics
NPI:1427180124
Name:RUSSELL, SARAMMA MATHEW (DNP, FNP-BC, APRN)
Entity Type:Individual
Prefix:
First Name:SARAMMA
Middle Name:MATHEW
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:DNP, FNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 BEEKMAN DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1209
Mailing Address - Country:US
Mailing Address - Phone:713-560-1459
Mailing Address - Fax:281-972-9242
Practice Address - Street 1:2626 S LOOP W STE 430
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2649
Practice Address - Country:US
Practice Address - Phone:713-560-1459
Practice Address - Fax:281-972-9242
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX583494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1501082-02Medicaid
TXP93583Medicare UPIN