Individual
MRS. REBECCA HALL RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNNP
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5260
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5260
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
R785141
MS
363L00000X
Nurse Practitioner
Primary
785141
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06107379
—
MS
05
—
2379577
—
LA
Enumeration date
09/24/2007
Last updated
05/22/2017
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