Individual
JOHN CALVIN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2201 N BROADWELL AVE, GRAND ISLAND, NE 68803-2153
(308) 382-3660
(308) 395-3214
Mailing address
2201 N BROADWELL AVE, GRAND ISLAND, NE 68803-2153
(308) 382-3660
(308) 395-3214
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
815
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47078557539
—
NE
Enumeration date
05/15/2006
Last updated
04/25/2017
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