Provider Demographics
NPI:1124786520
Name:RUSSELL, HEATHER LEE (FNP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:601 ELMWOOD AVENUE BOX 679B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-3760
Mailing Address - Fax:585-273-1129
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-273-3760
Practice Address - Fax:585-273-1129
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY348860207XS0106X
NYF3488601-01363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery