MEDICARE: DENISE CHARMAINE 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	163WE0003X	Emergency Registered Nurse	RN9293182	FL

General Provider Information

NPI Number	:	1922697077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE CHARMAINE RUSSELL RN

Provider Business Mailing Address
First Line	:	10640 OLD GROVE CIR
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34212-2605
Country	:	US
Telephone Number	:	941-730-0635
Fax Number	:

Provider Business Practice Location Address
First Line	:	10640 OLD GROVE CIR
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34212-2605
Country	:	US
Telephone Number	:	941-730-0635
Fax Number	:	941-708-9308

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

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	01/13/2021

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