Provider Demographics
NPI:1457873457
Name:RUSSELL, JAIMIE ANN MASTERS (APRN)
Entity Type:Individual
Prefix:
First Name:JAIMIE
Middle Name:ANN MASTERS
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JAIMIE
Other - Middle Name:
Other - Last Name:MASTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7441 O ST STE 400
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2466
Mailing Address - Country:US
Mailing Address - Phone:402-464-9000
Mailing Address - Fax:402-464-4447
Practice Address - Street 1:7441 O ST STE 400
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2466
Practice Address - Country:US
Practice Address - Phone:402-464-9000
Practice Address - Fax:402-464-4447
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112265363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEPENDINGMedicaid