Russell James Niffenegger, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R42886 Issued in ND

Practice address

2100 S Columbia Rd Ste 114
Grand Forks, ND 58201-5895

Phone

(701) 516-4637

Fax

(877) 651-1381

NPI assigned

Aug 14, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Russell Milton Willis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legacy Primary Care PLLC

  • Adult Medicine Physician
  • Grand Forks, ND
  • NPI 1265277115
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1691971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711584000000",
    "number": "1659154706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1079 DEER TRAIL LN NE",
            "city": "THOMPSON",
            "state": "ND",
            "postal_code": "582789400",
            "telephone_number": "701-740-9272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 S COLUMBIA RD STE 114",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582015895",
            "telephone_number": "701-516-4637",
            "fax_number": "877-651-1381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIFFENEGGER",
        "first_name": "RUSSELL",
        "middle_name": "JAMES",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-08-14",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "R42886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RUSSELL",
            "last_name": "WILLIS",
            "middle_name": "MILTON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amber Michelle Nickerson, MS CF SLP
• Erik Niec, M.D.
• A Marc Nielsen, MD
• Sonya Kay Nielson, M.S. CCC-SLP
• Angela S Niffenegger, LICSW LAC LADC
• Elvira Nixon, CNA, TMA, QSP.
• Sylvia Chitom Nnamdi-Enwerem
• Jade Makae Noah, LAPC
• Nodak Optics Dba Pearle Vision
• Amy Noeldner, HIS

• Family Nurse Practitioner in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Family Nurse Practitioner in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.