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General NPI Number Information
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NPI Number | 1811121551
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Entity Type | Individual
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Provider Name | REGINALD TAYLOR RUSSELL II NP
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Gender | Male
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 1919 COMMERCE DR
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City | HAMPTON
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State | VA
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Zip | 23666-4269
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Country | US
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Telephone | 757-223-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 104 ROCKLAND TER
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City | SUFFOLK
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State | VA
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Zip | 23434-2053
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Country | US
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Telephone | 804-304-4884
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 2008010430
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024178243
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License Number State | VA
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