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General NPI Number Information
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NPI Number | 1780111070
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Entity Type | Individual
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Provider Name | CHRISTOPHER G RUSSELL CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 1150 N INDIAN CANYON DR
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City | PALM SPRINGS
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State | CA
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Zip | 92262-4872
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Country | US
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Telephone | 760-323-6511
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Fax |
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Provider Business Mailing Address
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Address Line | 2696 S SIERRA MADRE UNIT F17
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City | PALM SPRINGS
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State | CA
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Zip | 92264-9465
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Country | US
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Telephone | 901-832-4071
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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 | 95225332
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 23064
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 95001385
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 171481
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License Number State | TN
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