Individual
LAURALEI S RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN, BC
Contact information
Practice address
920 UNIVERSITY ST, MARTIN, TN 38237-1605
(731) 588-5829
(731) 587-8810
Mailing address
920 UNIVERSITY ST, MARTIN, TN 38237-1605
(731) 588-5829
(731) 587-8810
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
98960
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3901295
—
TN
05
—
3901296
—
TN
01
—
4083487
BCBS OF TN SYMED
TN
01
—
4100240
BCBS OF TN MPAC
TN
01
—
P00095364
RAILROAD MEDICARE
TN
Enumeration date
01/13/2006
Last updated
10/21/2013
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