Provider Demographics
NPI:1740821818
Name:RUSSEL, SARAH MARIE (FNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:RUSSEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 PIMMIT DR
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-1306
Mailing Address - Country:US
Mailing Address - Phone:703-593-9021
Mailing Address - Fax:
Practice Address - Street 1:5255 LOUGHBORO ROAD, NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-1709
Practice Address - Country:US
Practice Address - Phone:202-243-5295
Practice Address - Fax:202-537-4662
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178066363LF0000X
DCRN1055645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily