| Provider / Organization | NPI | Date Certified |
|---|---|---|
| DEIDRE MICHELLE RUSSELL | 1770702979 | 2024-11-08 |
Deidre Russell [F] graduated in 2006 and primarily specializes in Certified Nurse Midwife (cnm).
Deidre Michelle Russell is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1770702979. Registration indicates Deidre Michelle Russell is a provider of access to ob/gyn services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Advanced Practice Midwife (Physician Assistants & Advanced Practice Nursing Providers, Advanced Practice Midwife) (Advanced Practice Midwife, ) (All Other Specialties & Provider Types, ) (Advanced Practice Midwife, Physician Assistants & Advanced Practice Nursing Providers)
| PECOS ID | 547423576 |
| Registration | PART-B:Y DME:Y HHA:N PMD:N |
| Entity Type | Individual |
| Provider Name | Ms. Deidre Michelle Russell CNM |
| Practice Office Address | 724 NW 43RD ST GAINESVILLE, FL US |
| Practice Office Telephone | 3523327222 |
| Practice Office Fax | 3523327330 |
| Mailing Address | 724 NW 43RD ST GAINESVILLE, FL 326076110 US |
| Business Telephone | 3523327222 |
| Business Fax | 3523327330 |
| Code | Practice | License No State |
|---|---|---|
| 367A00000X PRIMARY | Access to OB/GYN Physician Assistants & Advanced Practice Nursing Providers Advanced Practice Midwife Physician Assistants & Advanced Practice Nursing Providers Advanced Practice Midwife Advanced Practice Midwife All Other Specialties & Provider Types Advanced Practice Midwife Physician Assistants & Advanced Practice Nursing Providers | 1757432
FL |