MEDICARE: MS. EMILY L RUSS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	4355-23	WI
2	363A00000X	Physician Assistant	121931	IA

General Provider Information

NPI Number	:	1457436966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY L RUSS PA

Provider Business Mailing Address
First Line	:	3 NEENAH CTR
Second Line	:
City	:	NEENAH
State	:	WI
Zip	:	54956-3070
Country	:	US
Telephone Number	:	920-723-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 2ND ST
Second Line	:
City	:	NEENAH
State	:	WI
Zip	:	54956-2883
Country	:	US
Telephone Number	:	920-720-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	02/03/2026

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