MEDICARE: RUSSELL MARTIN ELMS

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	363LF0000X	Family Nurse Practitioner	95019159	CA

General Provider Information

NPI Number	:	1053078295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL MARTIN ELMS

Provider Business Mailing Address
First Line	:	730 N I ST STE 104
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93637-3078
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 E YOSEMITE AVE
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93638-3604
Country	:	US
Telephone Number	:	559-664-4000
Fax Number	:

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

Provider Enumeration Date	:	11/23/2021
Last Update Date	:	06/07/2023

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Directions to “ RUSSELL MARTIN ELMS ” Practice Location

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