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NPI Code Detail

MEDICARE: BERNADETTE RUSSELL CPNP

MEDICARE: BERNADETTE RUSSELL CPNP
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
1363LP0200XPediatric Nurse PractitionerR186183MD

General Provider Information

NPI Number : 1427425875
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERNADETTE RUSSELL CPNP
Provider Business Mailing Address
First Line : 1213 HARBOR ISLAND WALK
Second Line :
City : BALTIMORE
State : MD
Zip : 21230-5461
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1213 HARBOR ISLAND WALK
Second Line :
City : BALTIMORE
State : MD
Zip : 21230-5461
Country : US
Telephone Number : 610-209-4132
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2015
Last Update Date : 09/01/2015

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Directions to “ BERNADETTE RUSSELL CPNP” Practice Location

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