Provider Demographics
NPI:1871836858
Name:RUSSELL, DEBRA LYNN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:LYNN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:ELBERTA
Mailing Address - State:AL
Mailing Address - Zip Code:36530-0519
Mailing Address - Country:US
Mailing Address - Phone:251-986-7301
Mailing Address - Fax:251-986-5927
Practice Address - Street 1:24980 STATE STREET
Practice Address - Street 2:PO DRAWER 519
Practice Address - City:ELBERTA
Practice Address - State:AL
Practice Address - Zip Code:36530
Practice Address - Country:US
Practice Address - Phone:251-986-7301
Practice Address - Fax:251-986-5927
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1097550363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner