MEDICARE: NATHAN W RUSSELL FNP

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	363L00000X	Nurse Practitioner	RN113668	TN
2	363L00000X	Nurse Practitioner	APN7542	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992708911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN W RUSSELL FNP

Provider Business Mailing Address
First Line	:	166 E MAIN ST
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-2520
Country	:	US
Telephone Number	:	615-822-3000
Fax Number	:	615-822-0073

Provider Business Practice Location Address
First Line	:	166 E MAIN ST
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-2520
Country	:	US
Telephone Number	:	615-822-3000
Fax Number	:	615-822-0073

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/28/2013

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