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NPI Code Detail

MEDICARE: ANNETTE M RUSSELL PA-C

MEDICARE: ANNETTE M RUSSELL PA-C
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
1363AM0700XMedical Physician Assistant205WY

General Provider Information

NPI Number : 1861439838
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNETTE M RUSSELL PA-C
Provider Business Mailing Address
First Line : 1230 E 1ST ST
Second Line :
City : CASPER
State : WY
Zip : 82601-2704
Country : US
Telephone Number : 307-266-3174
Fax Number : 307-261-6713
Provider Business Practice Location Address
First Line : 1230 E 1ST ST
Second Line :
City : CASPER
State : WY
Zip : 82601-2704
Country : US
Telephone Number : 307-266-3174
Fax Number : 307-261-6713
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2006
Last Update Date : 07/08/2007

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Directions to “ ANNETTE M RUSSELL PA-C” Practice Location

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