Healthcare Provider Details

I. General information

NPI: 1417018425
Provider Name (Legal Business Name): CHERIE RUSSELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

25 MCWILLIAMS PLACE # 307
JERSEY CITY NJ
07302-1650
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7000
  • Fax:
Mailing address:
  • Phone: 917-743-1823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number450021
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number304690
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: