Healthcare Provider Details

I. General information

NPI: 1205386984
Provider Name (Legal Business Name): CATHERINE A RUSSELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 READS WAY STE 201
NEW CASTLE DE
19720-1630
US

IV. Provider business mailing address

2 READS WAY STE 201
NEW CASTLE DE
19720-1630
US

V. Phone/Fax

Practice location:
  • Phone: 302-709-4547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL6-0A00768
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: