Healthcare Provider Details

I. General information

NPI: 1992125744
Provider Name (Legal Business Name): LAURA NOELLE RUSSELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DIVISION OF NEONATOLOGY 2200 CHILDRENS WAY
NASHVILLE TN
37232
US

IV. Provider business mailing address

3841 GREEN HILLS VILLAGE DR STE 200
NASHVILLE TN
37215-2691
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-3475
  • Fax:
Mailing address:
  • Phone: 615-936-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0000055703
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number55703
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: