Healthcare Provider Details

I. General information

NPI: 1629992425
Provider Name (Legal Business Name): ADRIAN OBRYAN RUSSELL MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 E ESSEX AVE APT B
LANSDOWNE PA
19050-1705
US

IV. Provider business mailing address

327 E ESSEX AVE APT B
LANSDOWNE PA
19050-1705
US

V. Phone/Fax

Practice location:
  • Phone: 484-557-0316
  • Fax:
Mailing address:
  • Phone: 484-557-0316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP036213
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: