Individual
AMANDA ELIZABETH RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
47 FAIRWAY PL, SELMER, TN 38375-1548
(901) 268-8401
Mailing address
47 FAIRWAY PL, SELMER, TN 38375-1548
(901) 268-8401
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
APN0000030233
TN
Other
Enumeration date
09/16/2021
Last updated
09/16/2021
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