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General NPI Number Information
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NPI Number | 1285968461
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Entity Type | Individual
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Provider Name | IYAKU TERRELL-RUSS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 6825 W BROWN DEER RD UNIT 241986
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City | MILWAUKEE
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State | WI
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Zip | 53224-6093
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Country | US
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Telephone | 414-699-9034
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Fax |
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Provider Business Mailing Address
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Address Line | 6825 W BROWN DEER RD UNIT 241986
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City | MILWAUKEE
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State | WI
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Zip | 53224-6093
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Country | US
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Telephone | 414-699-9034
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 165570-30
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 7470-33
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License Number State | WI
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