Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 71006647A | IN |
NPI | 1033660188 |
---|---|
Provider Name | Lindsay Russell |
First Address | Indianapolis, IN 46280-1091 |
Second Address | Indianapolis, IN 46280-1091 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2016 |
Last Update Date | 24/10/2016 |