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NPI Code Detail

MEDICARE: MADISON GARDNER RUSSELL

MEDICARE: MADISON GARDNER 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
1163W00000XRegistered Nurse332914NC

General Provider Information

NPI Number : 1467381145
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON GARDNER RUSSELL
Provider Business Mailing Address
First Line : 4693 FIRE DEPT RD
Second Line :
City : WILLIAMSTON
State : NC
Zip : 27892-7148
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2100 STANTONSBURG RD
Second Line :
City : GREENVILLE
State : NC
Zip : 27834-2818
Country : US
Telephone Number : 252-816-3714
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2026
Last Update Date : 05/18/2026

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Directions to “ MADISON GARDNER RUSSELL ” Practice Location

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