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NPI Code Detail

MEDICARE: CAMELLIA RUSSELL

MEDICARE:   CAMELLIA  RUSSELL
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
1390200000XStudent in an Organized Health Care Education/Training ProgramNJ

General Provider Information

NPI Number : 1093657553
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMELLIA RUSSELL
Provider Business Mailing Address
First Line : 312 ORLAND ST APT 64
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-1658
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 MADISON AVE
Second Line :
City : MORRISTOWN
State : NJ
Zip : 07960-6136
Country : US
Telephone Number : 973-971-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2026
Last Update Date : 04/06/2026

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Directions to “ CAMELLIA RUSSELL ” Practice Location

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