Individual
STEPHANIE NICOLE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
200 MADISON AVE STE 2D, ELMIRA, NY 14901-3219
(607) 873-1832
(607) 873-1833
Mailing address
571 SAINT JOSEPHS BLVD FL 2, ELMIRA, NY 14901-3230
(607) 271-2050
(607) 873-1244
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
308433
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04882968
—
NY
05
—
103436736
—
PA
Enumeration date
06/23/2017
Last updated
11/30/2020
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