Provider Demographics
NPI:1518779966
Name:RUSSELL, ELIZABETH ALEXIS (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ALEXIS
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ALEXIS
Other - Last Name:HEISLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RNC-OB
Mailing Address - Street 1:1025 WIDENER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-3242
Mailing Address - Country:US
Mailing Address - Phone:574-335-7600
Mailing Address - Fax:574-335-0734
Practice Address - Street 1:1025 WIDENER LN
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-3242
Practice Address - Country:US
Practice Address - Phone:574-335-7600
Practice Address - Fax:574-335-0734
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28268045A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse