MEDICARE: MICHELLE LEA 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	28162933A	IN

General Provider Information

NPI Number	:	1558929240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LEA RUSSELL RN

Provider Business Mailing Address
First Line	:	7322 NOEL RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-1515
Country	:	US
Telephone Number	:	877-659-4555
Fax Number	:

Provider Business Practice Location Address
First Line	:	7322 NOEL RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-1515
Country	:	US
Telephone Number	:	877-659-4555
Fax Number	:

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

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	05/29/2019

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