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NPI Code Detail

MEDICARE: MRS. JASMINE RUSSELL

MEDICARE: MRS. JASMINE RUSSELL
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
1363A00000XPhysician Assistant0110009717VA
2363A00000XPhysician AssistantC0008212MD

General Provider Information

NPI Number : 1841829116
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JASMINE RUSSELL
Provider Business Mailing Address
First Line : 5000 COX RD
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-9263
Country : US
Telephone Number : 804-822-4355
Fax Number :
Provider Business Practice Location Address
First Line : 21044 FREDERICK RD
Second Line :
City : GERMANTOWN
State : MD
Zip : 20876-4132
Country : US
Telephone Number : 240-238-5432
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2020
Last Update Date : 02/20/2024

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Directions to “ MRS. JASMINE RUSSELL ” Practice Location

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