Provider Demographics
NPI:1023459393
Name:RUSSELL, RACHELLE (APRN NP-C)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:APRN NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 W VINE ST STE 232
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5492
Mailing Address - Country:US
Mailing Address - Phone:801-716-1007
Mailing Address - Fax:385-351-3664
Practice Address - Street 1:244 W VINE ST STE 232
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5492
Practice Address - Country:US
Practice Address - Phone:801-716-1007
Practice Address - Fax:385-351-3664
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6298718-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily