Provider Demographics
NPI:1730375031
Name:RUSSELL, DAWN RENEE' (ARNP, CPNP)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:RENEE'
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:ARNP, CPNP
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:RENEE'
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10706 CLEMSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-4528
Mailing Address - Country:US
Mailing Address - Phone:864-888-3020
Mailing Address - Fax:864-888-8585
Practice Address - Street 1:10706 CLEMSON BLVD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4528
Practice Address - Country:US
Practice Address - Phone:864-888-3020
Practice Address - Fax:864-888-8585
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3310363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics