MEDICARE: MRS. JACQUELINE MARIE RUSSELL RN MSN APNC

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	26NN06637900	NJ

General Provider Information

NPI Number	:	1497858070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE MARIE RUSSELL RN MSN APNC

Provider Business Mailing Address
First Line	:	PO BOX 593
Second Line	:
City	:	CAPE MAY COURT HOUSE
State	:	NJ
Zip	:	08210-0593
Country	:	US
Telephone Number	:	609-463-2755
Fax Number	:	609-463-2757

Provider Business Practice Location Address
First Line	:	4011 ROUTE 9 S
Second Line	:	SUITE 201
City	:	RIO GRANDE
State	:	NJ
Zip	:	08242-1916
Country	:	US
Telephone Number	:	609-770-7788
Fax Number	:	609-770-7774

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	02/22/2013

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