Provider Demographics
NPI:1144411026
Name:RUSSELL, JANIE CADDIS (FNP)
Entity type:Individual
Prefix:
First Name:JANIE
Middle Name:CADDIS
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591-1 STATE HWY 20
Mailing Address - Street 2:
Mailing Address - City:SHARON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13459
Mailing Address - Country:US
Mailing Address - Phone:518-284-2223
Mailing Address - Fax:518-284-8449
Practice Address - Street 1:591-1 STATE HWY 20
Practice Address - Street 2:
Practice Address - City:SHARON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:13459
Practice Address - Country:US
Practice Address - Phone:518-284-2223
Practice Address - Fax:518-284-8449
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33280363LF0000X
NYF332820-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily