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General NPI Number Information
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NPI Number | 1295928570
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Entity Type | Individual
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Provider Name | AKIMYO CHAMPION RUSSELL FNP
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Gender | Female
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 6200-A OLD FRANCONIA ROAD
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City | ALEXANDRIA
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State | VA
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Zip | 22310
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Country | US
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Telephone | 703-884-8494
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Fax | 703-313-0178
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Provider Business Mailing Address
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Address Line | 224-D CORNWALL STREET, NW, SUITE 403
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City | LEESBURG
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State | VA
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Zip | 20176-2704
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Country | US
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Telephone | 703-737-6010
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Fax | 703-443-8643
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R178581
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License Number State | MD
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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 | 5004213
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024170178
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License Number State | VA
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