Healthcare Provider Details

I. General information

NPI: 1285701243
Provider Name (Legal Business Name): ANN B RUSSELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN B. KELTGEN

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11602 W CENTER RD SUITE 150
OMAHA NE
68144-4440
US

IV. Provider business mailing address

11602 W CENTER RD SUITE 150
OMAHA NE
68144-4440
US

V. Phone/Fax

Practice location:
  • Phone: 402-991-7337
  • Fax: 402-991-7373
Mailing address:
  • Phone: 402-991-7337
  • Fax: 402-991-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19783
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: