MEDICARE: CAROL LYNN RUSSELL CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	54607	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023089042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL LYNN RUSSELL CRNA

Provider Business Mailing Address
First Line	:	3705 N 139TH ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-4234
Country	:	US
Telephone Number	:	913-721-3641
Fax Number	:	913-721-3649

Provider Business Practice Location Address
First Line	:	5520 COLLEGE BLVD
Second Line	:	SUITE 200
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1630
Country	:	US
Telephone Number	:	913-491-3040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	10/21/2008

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