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General NPI Number Information
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NPI Number | 1417018425
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Entity Type | Individual
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Provider Name | CHERIE RUSSELL NP
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 550 1ST AVE
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City | NEW YORK
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State | NY
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Zip | 10016-6402
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Country | US
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Telephone | 212-263-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 25 MCWILLIAMS PLACE # 307
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City | JERSEY CITY
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State | NJ
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Zip | 07302-1650
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Country | US
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Telephone | 917-743-1823
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 450021
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 304690
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License Number State | NY
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