Individual
DR. MARYELLEN DYER-RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, PMHNP-BC
Contact information
Practice address
1911 WILLIAMS DR, OXNARD, CA 93036-2612
(805) 981-6830
(805) 289-3395
Mailing address
800 S VICTORIA AVE, L4615, VCHCA - PHYSICIAN SERVICES, VENTURA, CA 93009-0003
(805) 677-5181
(805) 677-5304
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
B333567-9664
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
9664
CA
Other
Enumeration date
03/05/2007
Last updated
07/02/2021
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