DR. MARYELLEN DYER-RUSSELL DNP PMHNP-BC NPI 1174652002

NPI Information

NPI: 1174652002
Provider Name: DR. MARYELLEN DYER-RUSSELL, DNP, PMHNP-BC
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
1911 WILLIAMS DR
OXNARD, CA
ZIP 93036
Phone: (805) 981-6830
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DR. Maryellen Dyer-russell, DNP, PMHNP-BC is a psychiatric/mental health nurse practitioner in Oxnard, CA. DR. Maryellen Dyer-russell, DNP, PMHNP-BC NPI is 1174652002. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1911 WILLIAMS DR
OXNARD, CA
ZIP 93036-612
Phone: (805) 981-6830
Fax: (805) 289-3395

The NPI 1174652002 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/5/2007 and was last updated on 7/2/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0200X	Nurse Practitioner	Pediatrics	B333567-9664	CALIFORNIA	No
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	9664	CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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