MEDICARE: JULIE L. RUSSELL NP

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	363LF0000X	Family Nurse Practitioner	108385	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00030899	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225024839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE L. RUSSELL NP

Provider Business Mailing Address
First Line	:	54 HOSPITAL DR
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3050
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 A EAST 4TH ST
Second Line	:
City	:	ELDON
State	:	MO
Zip	:	65026
Country	:	US
Telephone Number	:	573-392-5654
Fax Number	:	573-392-5692

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	05/05/2008

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