Healthcare Provider Details

I. General information

NPI: 1568415909
Provider Name (Legal Business Name): KAREN J RUSSELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FORREST AVE
DOVER DE
19904-3309
US

IV. Provider business mailing address

640 S STATE ST 742 BUILDING
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-672-4600
  • Fax: 302-672-4606
Mailing address:
  • Phone: 302-674-3970
  • Fax: 302-672-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG0000540
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberLZ0000110
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: