Healthcare Provider Details

I. General information

NPI: 1386617496
Provider Name (Legal Business Name): ERICA M RUSSELL ARNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PRIMROSE ST STE 202
HAVERHILL MA
01830-2659
US

IV. Provider business mailing address

24 MORRILL PL STE 2
AMESBURY MA
01913-3530
US

V. Phone/Fax

Practice location:
  • Phone: 978-556-0100
  • Fax: 978-556-0101
Mailing address:
  • Phone: 978-834-8074
  • Fax: 978-834-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number045794-23-03
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN227640
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number045794-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: