Provider Demographics
NPI:1508158510
Name:RUSSELL, JANINE I (APMHNP)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:I
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:APMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DOWNTOWN HEALING CREATIVE ARTS CENTER
Mailing Address - Street 2:313 SECOND STREET SE, SUITE 211
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902
Mailing Address - Country:UM
Mailing Address - Phone:434-829-2330
Mailing Address - Fax:
Practice Address - Street 1:313 2ND ST SE STE 211
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5686
Practice Address - Country:US
Practice Address - Phone:434-829-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169363363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health