Stacy Lee Russell, NP
Nurse Practitioner in Ann Arbor, MI. Individual provider (NPI-1).
NPI number1760802433
StatusActive
Last updated in NPPESDec 31, 2019
Details
- NPI
- 1760802433
- Entity type
- Individual (NPI-1)
- Name
- Stacy Lee Russell
- Credential
- NP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 22, 2014
- Certification date
- Dec 31, 2019
- Last updated
- Dec 31, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | 4704207197 | MI | Yes |
Practice location
2850 S Industrial Hwy Ste 50Ann Arbor, MI 48104-6792
Phone 734-477-7228
Mailing address
3621 S State StAnn Arbor, MI 48108-1633
Phone 734-647-5299
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