person
Ms. Shannon R Russom, NP
Family Nurse Practitioner in Williston, Vermont
NPI 1013948850

Shannon R Russom is a Family Nurse Practitioner based in Huntington, VT and is specialized in Family. Shannon R Russom practices in Williston, VT and has the professional credentials of NP. The NPI Number for Shannon R Russom is 1013948850 and holds a License No. 1010017858 (Vermont).

The current practice location address for Shannon R Russom is 353 Blair Park Rd, Williston, VT and can be reached out via phone at 802-847-1600 and via fax at 802-847-7184. You can also correspond with Shannon R Russom through the mailing address at 87 CARSE RD, HUNTINGTON, VT - 05462-9550 (mailing address contact number: 802-434-4195).

Location: 353 Blair Park Rd, Williston, VT, 05462-9550
person
Provider Profile Details
NPI Number
1013948850
Provider Name
Shannon R Russom
Credential
NP
Provider Entity Type
Individual
Gender
Female
Address
353 Blair Park Rd, Williston, VT, 05462-9550
Phone Number
802-847-1600
Fax Number
802-847-7184
Provider Enumeration Date
07/06/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1008958 05 VT
150268 01 VT MVP
58796 01 VT BLUE SHIELD
6309101 01 VT APEX
institution
Provider Business Practice Location Address Details
Address
353 Blair Park Rd
City
State
Zip
05495-7530
Phone Number
802-847-1600
Fax Number
802-847-7184
person
Provider Business Mailing Address Details
Address
353 Blair Park Rd
City
State
Zip
05495-7530
Phone Number
802-847-1600
Fax Number
802-847-7184
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
License No.
1010017858 (Vermont)
Definition
Definition to come...
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