MS. SHANNON R RUSSOM (NPI# 1013948850) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013948850 |
| Entity Type | Individual |
| Full Name | MS. SHANNON R RUSSOM |
| Credential | N.P. |
| Practice Address |
353 Blair Park Rd Williston VT 05495-7530 |
| Mailing Address |
87 Carse Rd Huntington VT 05462-9550 |
| Practice Telephone | 8028471600 |
| Practice Fax Number | 8028477184 |
| Mailing Telephone | 8024344195 |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
1010017858 | VT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VT | APEX | 6309101 | 01 |
| VT | BLUE SHIELD | 58796 | 01 |
| VT | 1008958 | 05 | |
| VT | MVP | 150268 | 01 |
| Street Address |
353 BLAIR PARK RD |
| City | WILLISTON |
| State | VT |
| Zip Code | 05495-7530 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639126774 | Bonitta C Steuer | Advanced Practice Midwife | 353 Blair Park Rd, Williston, VT 05495-7530 | 2006-05-27 |
| 1205458056 | Elisa Vautier | Registered Nurse | 353 Blair Park Rd, Williston, VT 05495-7530 | 2020-05-15 |
| 1356711659 | Amber Snow | Registered Nurse | 353 Blair Park Rd, Williston, VT 05495-7530 | 2015-09-29 |
| 1821490921 | Genevieve Flanders | Physician Assistant | 353 Blair Park Rd, Williston, VT 05495-7530 | 2014-09-19 |
| 1992142939 | Alexandra L Messerli | Internal Medicine | 353 Blair Park Rd, Williston, VT 05495-7530 | 2013-05-31 |
| 1841580859 | Kirsten Berggren | Nurse Practitioner | 353 Blair Park Rd, Williston, VT 05495-7530 | 2011-04-11 |
| 1124297007 | Fletcher Allen Health Care-blair Park | Durable Medical Equipment & Medical Supplies | 353 Blair Park Rd, Williston, VT 05495-7530 | 2008-02-26 |
| 1609084755 | Hima B Kanuparthi | Dietitian, Registered | 353 Blair Park Rd, Williston, VT 05495-7530 | 2007-05-21 |
| 1013072347 | Lucy Miller | Internal Medicine | 353 Blair Park Rd, Williston, VT 05495-7530 | 2006-12-27 |
| 1992893242 | Fletcher Allen Health Care,inc | Durable Medical Equipment & Medical Supplies | 353 Blair Park Rd, Williston, VT 05495-7530 | 2006-10-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588271977 | Rachel D. Oblak | Counselor | 8031 Williston Rd. Suite 2, Williston, VT 05495 | 2020-09-29 |
| 1164986386 | Caitlin Taylor Henck | Behavioral Analyst | 37 Talcott Road, Williston, VT 05495 | 2019-01-23 |
| 1497273585 | Williston Health Supplies | Durable Medical Equipment & Medical Supplies | 34 Blair Park Road, Suite 104 #302, Williston, VT 05495 | 2017-09-08 |
| 1245755057 | Jennifer L Cadorette | Physical Therapist | 1193 S Brownell Rd Ste 20, Williston, VT 05495 | 2017-08-14 |
| 1538563317 | Pamela Guiduli Nash | Psychologist | 277 Blair Park, Suite 210, Williston, VT 05495 | 2014-10-22 |
| 1205277118 | Daniel J Cho | Dentist | 62 Merchants Row, Williston, VT 05495 | 2013-07-09 |
| 1134473218 | Vermont Technical College Department of Denta | Dentist | 301 Lawrence Place, Williston, VT 05495 | 2012-10-29 |
| 1689923864 | Megan Marie Quiet | Specialist/Technologist | 115 Wellness Drive, Williston, VT 05495 | 2012-09-05 |
| 1285981365 | Allison Marie Bogan | Chiropractor | 300 Cornerstone Dr. Ste 215, Williston, VT 05495 | 2012-08-08 |
| 1114229937 | Bayada Home Health Care, Inc. | Registered Nurse | 600 Blair Park Rd Ste 300, Williston, VT 05495 | 2010-11-30 |
| Find all providers in zip 05495 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740747047 | Camilla Dawn Pace | Nurse Practitioner | 37 S Main St Ste A, Williston, FL 32696-2681 | 2019-02-23 |
| 1417277500 | Tara Blue Meyer | Nurse Practitioner | 353 Blair Pk. Rd., Uvm Medical Center - PCim/williston, Williston, VT 05495 | 2010-06-11 |
| 1881656361 | Rita Laverne Long Arrington | Nurse Practitioner | 130 Sw 7th Street, Williston, FL 32696-2404 | 2006-04-03 |
| 1487251930 | Elizabeth Coulson | Nurse Practitioner | 1301 15th Ave W, Williston, ND 58801-3821 | 2020-10-07 |
| 1740822584 | Anna Elizabeth Wolf | Nurse Practitioner | 1301 15th Ave W, Williston, ND 58801-3821 | 2019-10-14 |
| 1174181333 | Tonya L Jones | Nurse Practitioner | 630 N Main St, Williston, FL 32696-1705 | 2019-06-03 |
| 1831685767 | Mirsada Nurkanovic | Nurse Practitioner | 586 Oak Hill Rd, Williston, VT 05495-7103 | 2018-07-03 |
| 1093219685 | Nana Oforiwaa Boateng | Nurse Practitioner | 1301 15th Ave W, Williston, ND 58801-3821 | 2018-03-20 |
| 1831606326 | Lily Stolberg | Nurse Practitioner | 586 Oak Hill Rd, Williston, VT 05495-7103 | 2018-01-05 |
| 1669901591 | Tiah Elizabeth Rigby | Nurse Practitioner | 1301 15th Ave W, Williston, ND 58801-3821 | 2017-06-05 |
| Find all providers in WILLISTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.