Healthcare Provider Details

I. General information

NPI: 1225315500
Provider Name (Legal Business Name): SARAH R RUSSELL DNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 RUBIN DR
RUSHVILLE NY
14544-9681
US

IV. Provider business mailing address

2 RUBIN DR
RUSHVILLE NY
14544-9681
US

V. Phone/Fax

Practice location:
  • Phone: 585-554-4400
  • Fax:
Mailing address:
  • Phone: 585-554-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number339628
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339628-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: