Provider Demographics
NPI:1255627030
Name:RUSSELL, MEREDITH RENEE (MS PNP)
Entity type:Individual
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First Name:MEREDITH
Middle Name:RENEE
Last Name:RUSSELL
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Gender:F
Credentials:MS PNP
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Mailing Address - Street 1:513 PARNASSUS AVE # 672
Mailing Address - Street 2:BOX 0434
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0434
Mailing Address - Country:US
Mailing Address - Phone:415-476-5349
Mailing Address - Fax:415-476-8214
Practice Address - Street 1:400 PARNASSUS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0434
Practice Address - Country:US
Practice Address - Phone:415-353-7337
Practice Address - Fax:415-476-8214
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
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Provider Licenses
StateLicense IDTaxonomies
CA707640363LA2100X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care