MEDICARE: KRISTIN MARIE RUSSELL RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.336079-	OH

General Provider Information

NPI Number	:	1144584426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MARIE RUSSELL RN

Provider Business Mailing Address
First Line	:	145 MONROE AVE
Second Line	:
City	:	FINDLAY
State	:	OH
Zip	:	45840-3733
Country	:	US
Telephone Number	:	419-615-2335
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 MONROE AVE
Second Line	:
City	:	FINDLAY
State	:	OH
Zip	:	45840-3733
Country	:	US
Telephone Number	:	419-615-2335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2012
Last Update Date	:	07/01/2012

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