Provider Demographics
NPI:1902948318
Name:RUSSELL, LAURA MAY (CNM, RN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MAY
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:CNM, RN
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Other - Credentials:
Mailing Address - Street 1:1718 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5700
Practice Address - Country:US
Practice Address - Phone:813-684-2229
Practice Address - Fax:813-813-0330
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9359072367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014411200Medicaid