Healthcare Provider Details

I. General information

NPI: 1497732549
Provider Name (Legal Business Name): SARAH E. RUSSELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 SUNSET LN STE 301
CULPEPER VA
22701-3979
US

IV. Provider business mailing address

PO BOX 21975
BELFAST ME
04915-4116
US

V. Phone/Fax

Practice location:
  • Phone: 540-825-4557
  • Fax: 540-825-4566
Mailing address:
  • Phone: 540-321-4281
  • Fax: 540-321-4282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024170117
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: