MEDICARE: CYNTHIA J RUSSELL ARNP

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	3654P	KY

General Provider Information

NPI Number	:	1518904663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA J RUSSELL ARNP

Provider Business Mailing Address
First Line	:	2109 OAKFORD CT
Second Line	:
City	:	LA GRANGE
State	:	KY
Zip	:	40031-7541
Country	:	US
Telephone Number	:	502-225-0709
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 DUPONT RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4692
Country	:	US
Telephone Number	:	502-895-2334
Fax Number	:	502-896-6987

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	10/11/2007

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