Provider Demographics
NPI:1518260207
Name:RUSSELL, LAUREN M (MS, RPA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MS, RPA-C
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:PAROLISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RPA-C
Mailing Address - Street 1:259 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3957
Mailing Address - Country:US
Mailing Address - Phone:516-663-8312
Mailing Address - Fax:516-663-2184
Practice Address - Street 1:259 1ST ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-663-0333
Practice Address - Fax:516-663-2184
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014454363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical