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General NPI Number Information
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NPI Number | 1184933145
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Entity Type | Individual
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Provider Name | RUSSELL VAN STROUD ACNP
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Gender | Male
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Dates
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Enumeration Date | 09/24/2010
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 118 W SPRING ST
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-5239
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Country | US
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Telephone | 479-575-4885
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Fax | 479-575-3218
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Provider Business Mailing Address
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Address Line | 118 W SPRING ST
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-5239
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Country | US
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Telephone | 479-575-4885
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Fax | 479-575-3218
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | F430548-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | NP19209
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | A03633
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License Number State | AR
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