Individual ProviderMaryanne RussellNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address9900 Bren Rd E, Minnetonka, MN 55343-9664(706) 896-3708PECOS EnrollmentBased on the most recent information from CMS, provider Maryanne Russell does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1588071369Provider TypeIndividualFull NameRussell, MaryanneCredentialNPGenderFemaleSole ProprietorYesEnumeration Date7/14/2014Last Updated9/20/2020Contact InformationPractice LocationPractice Address9900 Bren Rd E, Minnetonka, MN 55343-9664Phone(706) 896-3708FaxUnlisted FaxMailing LocationMailing AddressPO Box 13, Hiawassee, GA 30546-0013Phone(706) 896-3708FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseRN154916Georgia