Individual
MS. DEBRA G RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
225 PHYSICIANS PARK STE 203, POPLAR BLUFF, MO 63901-3921
(573) 686-4750
(573) 686-4753
Mailing address
PO BOX 699, POPLAR BLUFF, MO 63902-0699
(573) 686-4750
(573) 686-4753
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
MO076908
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
425335809
—
MO
Enumeration date
02/09/2006
Last updated
08/31/2012
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