Individual
TERRI LYNNE RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RN MS CNS
Contact information
Practice address
540 E 1ST ST, WACONIA, MN 55387-1601
(952) 442-4437
(952) 442-3084
Mailing address
540 E 1ST ST, WACONIA, MN 55387-1601
(952) 442-4437
(952) 442-3084
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
R-122719-6
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07F62RU
BLUE CROSS BLUE SHIELD
MN
01
—
1023258
PREFERRED ONE
MN
01
—
123169
U-CARE
MN
01
—
6249427
UBH-MEDICA
MN
01
—
HP28174
HEALTH PARTNERS
MN
Enumeration date
08/15/2005
Last updated
07/08/2007
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