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General NPI Number Information
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NPI Number | 1386425551
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Entity Type | Individual
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Provider Name | RUSS-EM JOHNSON RN, CCRN, CMC
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Gender | Female
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 5930 CORNERSTONE CT W STE 300
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City | SAN DIEGO
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State | CA
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Zip | 92121-3772
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Country | US
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Telephone | 866-687-7390
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Fax |
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Provider Business Mailing Address
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Address Line | 12100 3RD ST NE
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City | BLAINE
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State | MN
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Zip | 55434-1980
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Country | US
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Telephone | 763-439-9854
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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 | 2307099
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License Number State | MN
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