Provider Demographics
NPI:1932192317
Name:RUSSELL, ROSALEE ANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ROSALEE
Middle Name:ANN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ROSALEE
Other - Middle Name:ANN
Other - Last Name:RUDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1009 PENNSYLVANIA AVE
Mailing Address - Street 2:VA CLINIC
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2108
Mailing Address - Country:US
Mailing Address - Phone:641-683-4300
Mailing Address - Fax:
Practice Address - Street 1:1009 PENNSYLVANIA AVE
Practice Address - Street 2:VA CLINIC
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2108
Practice Address - Country:US
Practice Address - Phone:641-683-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072252163W00000X
IAA072252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00159657OtherRAILROAD MEDICARE
IA36761OtherWELLMARK INC BCBS OF IA
IA420681060D1OtherJOHN DEERE HEALTH
IA510437OtherIOWA HEALTH SOLUTIONS
IAUNKOtherTRIWEST
IA0440578Medicaid
IAP00159657OtherRAILROAD MEDICARE
IAUNKOtherTRIWEST
IAI21378Medicare PIN