Provider Demographics
NPI:1669206827
Name:RUSSELL, PAIGE NOELLE (APRN)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:NOELLE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MR
Other - First Name:PAIGE
Other - Middle Name:NOELLE
Other - Last Name:BERTHOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 DODSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37406-3214
Mailing Address - Country:US
Mailing Address - Phone:423-778-2800
Mailing Address - Fax:
Practice Address - Street 1:1200 DODSON AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-3214
Practice Address - Country:US
Practice Address - Phone:423-778-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36375363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner