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General NPI Number Information
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NPI Number | 1972217461
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Entity Type | Individual
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Provider Name | GRAHAM E RUSSELL BSN, DNP-CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 1055 N CURTIS RD
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City | BOISE
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State | ID
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Zip | 83706-1309
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Country | US
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Telephone | 208-367-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 E OVERLAND RD APT C212
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City | MERIDIAN
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State | ID
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Zip | 83642-8989
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Country | US
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Telephone | 971-344-5717
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN768430
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License Number State | PA
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