Provider Demographics
NPI:1104887140
Name:RUSSELL, SHERRY A (MSN APRN BC)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:A
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MSN APRN BC
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:A
Other - Last Name:SEEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1322 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079
Mailing Address - Country:US
Mailing Address - Phone:810-329-4798
Mailing Address - Fax:810-329-7303
Practice Address - Street 1:1322 N RIVER RD
Practice Address - Street 2:
Practice Address - City:ST CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079
Practice Address - Country:US
Practice Address - Phone:810-329-4798
Practice Address - Fax:810-329-7303
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704167606364SP0812X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Community
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI740113Medicaid
MI740113Medicaid