Provider Demographics
NPI:1851330286
Name:RUSSELL, PAMELA K (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:K
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 HAMMILL LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2045
Mailing Address - Country:US
Mailing Address - Phone:775-348-1313
Mailing Address - Fax:775-348-1798
Practice Address - Street 1:520 HAMMILL LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2045
Practice Address - Country:US
Practice Address - Phone:775-348-1313
Practice Address - Fax:775-348-1798
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6043207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016392Medicaid
NV2016392Medicaid
NV30034Medicare PIN