MEDICARE: APRIL RENEE RUSSELL CLD

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	374J00000X	Doula

General Provider Information

NPI Number	:	1508270406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRIL RENEE RUSSELL CLD

Provider Business Mailing Address
First Line	:	3026 OLIVE ST
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-4032
Country	:	US
Telephone Number	:	903-949-0081
Fax Number	:

Provider Business Practice Location Address
First Line	:	3026 OLIVE ST
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-4032
Country	:	US
Telephone Number	:	903-949-0081
Fax Number	:

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

Provider Enumeration Date	:	06/18/2014
Last Update Date	:	06/18/2014

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Directions to “ APRIL RENEE RUSSELL CLD” Practice Location

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