Healthcare Provider Details

I. General information

NPI: 1528492386
Provider Name (Legal Business Name): NANCY G RUSSELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY R GENTRY

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW GROUND FLOOR, DARNALL HALL, SUITE G20
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 202-687-2240
  • Fax:
Mailing address:
  • Phone: 410-933-0000
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP1038800
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5006364
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: