Provider Demographics
NPI:1487875159
Name:RUSSELL, CHARLOTTE ELIZABETH (CPM)
Entity type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:ELIZABETH
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-5262
Mailing Address - Country:US
Mailing Address - Phone:318-272-8295
Mailing Address - Fax:
Practice Address - Street 1:404 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5262
Practice Address - Country:US
Practice Address - Phone:318-272-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06001176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife