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NPI Code Detail

MEDICARE: TAMIKA JEAN RUSSAVAGE

MEDICARE: TAMIKA JEAN RUSSAVAGE
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
1163W00000XRegistered Nurse69653NE
2163WS0200XSchool Registered Nurse69653NE

General Provider Information

NPI Number : 1316768823
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMIKA JEAN RUSSAVAGE
Provider Business Mailing Address
First Line : 14568 CORBY ST
Second Line :
City : OMAHA
State : NE
Zip : 68116-5104
Country : US
Telephone Number : 402-334-8369
Fax Number : 531-299-1099
Provider Business Practice Location Address
First Line : 1807 S 60TH ST
Second Line :
City : OMAHA
State : NE
Zip : 68106-2151
Country : US
Telephone Number : 531-299-1080
Fax Number : 531-299-1099
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2024
Last Update Date : 10/18/2024

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Directions to “ TAMIKA JEAN RUSSAVAGE ” Practice Location

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