Individual
HANNAH B RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3040 BOURN ST, LEWISTON, MI 49756-8134
(989) 786-4877
(989) 786-2187
Mailing address
850 N OTSEGO AVE, SUITE 1, GAYLORD, MI 49735-1568
(989) 731-7708
(989) 731-7929
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007662
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F96004
GROUP MEDICARE
MI
Enumeration date
03/08/2016
Last updated
03/08/2016
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