Provider Demographics
NPI:1366731606
Name:RUSSELL, DEBRA P (R N)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:P
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 CANYON RUN RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-6608
Mailing Address - Country:US
Mailing Address - Phone:505-256-0977
Mailing Address - Fax:
Practice Address - Street 1:8401 CANYON RUN RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-6608
Practice Address - Country:US
Practice Address - Phone:505-256-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR24587163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse