Healthcare Provider Details

I. General information

NPI: 1679681001
Provider Name (Legal Business Name): HELEN KIRBY RUSSELL NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RICHLAND MEDICAL PARK DR SUITE 400
COLUMBIA SC
29203-6849
US

IV. Provider business mailing address

25 CORONET DR
COLUMBIA SC
29206-1314
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-6392
  • Fax:
Mailing address:
  • Phone: 803-787-9161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number2333
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: