Provider Demographics
NPI:1356622120
Name:RUSSELL, SAMARA DEVA (APRN, NP-C)
Entity type:Individual
Prefix:MRS
First Name:SAMARA
Middle Name:DEVA
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:APRN, NP-C
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Mailing Address - Street 1:475 KILVERT ST
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1379
Mailing Address - Country:US
Mailing Address - Phone:401-447-6090
Mailing Address - Fax:877-626-6891
Practice Address - Street 1:400 VALLEY RD STE 105
Practice Address - Street 2:
Practice Address - City:MOUNT ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856-2316
Practice Address - Country:US
Practice Address - Phone:973-770-7101
Practice Address - Fax:973-770-7108
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT004763363LA2200X
RICAPRN00529363LG0600X
CT4763364SX0106X
NJ26NJ0107800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No364SX0106XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOccupational Health