Provider Demographics
NPI:1851109573
Name:RUSSELL, ABIGAIL R
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:R
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 EDISTO CT
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1674
Mailing Address - Country:US
Mailing Address - Phone:260-704-0963
Mailing Address - Fax:
Practice Address - Street 1:6013 FARRINGTON RD STE 301
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8173
Practice Address - Country:US
Practice Address - Phone:984-974-6669
Practice Address - Fax:984-974-9609
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-27
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty