Individual
MRS. DONNA REVES RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
101 ELM AVE SE, CARILION ROANOKE COMMUNITY - NICU, 6TH AND 9TH FLOOR, ROANOKE, VA 24013-2222
(540) 985-8051
(540) 985-8005
Mailing address
1701 BLAIR RD SW, ROANOKE, VA 24015-3605
(540) 342-7942
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
0001116283
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
04/11/2007
Last updated
07/08/2007
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