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NPI Code Detail

MEDICARE: RUSS-EM JOHNSON RN, CCRN, CMC

MEDICARE: RUSS-EM JOHNSON RN, CCRN, CMC
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
1163W00000XRegistered Nurse2307099MN

General Provider Information

NPI Number : 1386425551
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUSS-EM JOHNSON RN, CCRN, CMC
Provider Business Mailing Address
First Line : 12100 3RD ST NE
Second Line :
City : BLAINE
State : MN
Zip : 55434-1980
Country : US
Telephone Number : 763-439-9854
Fax Number :
Provider Business Practice Location Address
First Line : 5930 CORNERSTONE CT W STE 300
Second Line :
City : SAN DIEGO
State : CA
Zip : 92121-3772
Country : US
Telephone Number : 866-687-7390
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2023
Last Update Date : 10/12/2023

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