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General NPI Number Information
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NPI Number | 1700408317
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Entity Type | Individual
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Provider Name | ANN CATHERINE RUSSELL PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 46 FAIRVIEW AVE
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City | SKOWHEGAN
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State | ME
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Zip | 04976-1481
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Country | US
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Telephone | 207-474-5121
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Fax | 207-474-3441
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Provider Business Mailing Address
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Address Line | PO BOX 468
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City | SKOWHEGAN
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State | ME
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Zip | 04976-0468
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Country | US
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Telephone | 207-858-8353
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Fax | 207-474-9261
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | TPA378
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA378
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA378
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License Number State | ME
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