Healthcare Provider Details

I. General information

NPI: 1982306833
Provider Name (Legal Business Name): CLAIRE MARIE RUSSELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 ARENDELL ST
MOREHEAD CITY NC
28557-4142
US

IV. Provider business mailing address

709 N JUSTICE ST
HENDERSONVILLE NC
28791-3454
US

V. Phone/Fax

Practice location:
  • Phone: 252-418-3411
  • Fax: 618-822-1087
Mailing address:
  • Phone: 828-696-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025-00534
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: