Individual
RANA WYNNE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
528 N CORONADO AVE, ESPANOLA, NM 87532-2790
(505) 747-6939
Mailing address
72 IRISH RD, RANCHOS DE TAOS, NM 87557-8753
(830) 660-2888
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
579441
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
147912305
—
TX
01
—
8N3798
BLUE CROSS/BLUE SHIELD
—
Enumeration date
09/07/2006
Last updated
03/22/2013
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