Individual provider · Type 1 NPI

Shannon R. Russom, N.P.

Family Nurse Practitioner · Williston, VT

NPI number 1013948850 Active

Practice location

353 Blair Park Rd
Williston, VT 05495-7530

Fax (802) 847-7184

Mailing address

87 Carse Rd
Huntington, VT 05462-9550

Specialties and licenses

TaxonomyCodeLicense
Family Nurse Practitioner Primary 363LF0000X1010017858 (VT)

Family Nurse Practitioner: Definition to come...

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About NPI 1013948850

Shannon R. Russom, N.P.'s National Provider Identifier is 1013948850, issued on Jul 6, 2006. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Williston, VT. The record was last updated on Jul 8, 2007.