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General NPI Number Information
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NPI Number | 1730429580
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Entity Type | Individual
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Provider Name | LORI JEAN RUSSELL NP
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Gender | Female
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Dates
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Enumeration Date | 02/14/2013
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Last Update Date | 02/14/2013
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Provider Practice Location Address
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Address Line | 11161 WASHINGTON BLVD
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City | WHITTIER
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State | CA
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Zip | 90606-3007
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Country | US
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Telephone | 562-695-2250
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Fax |
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Provider Business Mailing Address
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Address Line | 13729 LA CUARTA ST
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City | WHITTIER
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State | CA
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Zip | 90602-2516
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Country | US
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Telephone | 562-945-2075
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 22819
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License Number State | CA
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