Provider Demographics
NPI:1285701243
Name:RUSSELL, ANN B (MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:B
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:B
Other - Last Name:KELTGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11602 W CENTER RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4440
Mailing Address - Country:US
Mailing Address - Phone:402-991-7337
Mailing Address - Fax:402-991-7373
Practice Address - Street 1:11602 W CENTER RD
Practice Address - Street 2:SUITE 150
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4440
Practice Address - Country:US
Practice Address - Phone:402-991-7337
Practice Address - Fax:402-991-7373
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19783208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1200715Medicaid
NE1200713Medicaid
NE1200714Medicaid
NE1200712Medicaid
NE2932OtherMIDLANDS CHOICE
NE1200147Medicaid
NE1201468Medicaid
NE30715OtherBCBS OF NE
IA0961003Medicaid
NE1201187Medicaid
NE1200713Medicaid