Individual
MEGHAN M RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, FNP-BC
Contact information
Practice address
4061 OLD PESHTIGO ROAD, MARINETTE, WI 54143
(715) 732-8130
(715) 732-8131
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(143) 892-1314
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
7746-033
WI
363LF0000X
Family Nurse Practitioner
7746-033
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
7746-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100068863
—
WI
Enumeration date
06/12/2017
Last updated
02/10/2025
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