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General NPI Number Information
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NPI Number | 1124167051
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Entity Type | Individual
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Provider Name | MS. AYANNA NICOLE RUSSELL
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3875 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90062-1105
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Country | US
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Telephone | 323-290-4356
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Fax | 323-293-3327
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Provider Business Mailing Address
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Address Line | 7391 9TH ST APT 6
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City | BUENA PARK
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State | CA
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Zip | 90621-2746
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Country | US
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Telephone | 310-946-7979
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | VN167101
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License Number State | CA
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