Individual
AMY ELIZABETH RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(919) 784-3100
Mailing address
428 GRANITE SADDLE DR, ROLESVILLE, NC 27571-9745
(704) 996-5140
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5010255
NC
363LF0000X
Family Nurse Practitioner
F01171044
NC
Other
Enumeration date
02/01/2018
Last updated
08/07/2021
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