MEDICARE: MRS. KAREN LEAH RUSSELL RN

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	163WS0200X	School Registered Nurse	278191-1	NY

General Provider Information

NPI Number	:	1770866691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN LEAH RUSSELL RN

Provider Business Mailing Address
First Line	:	247 MAIN ST
Second Line	:
City	:	NEWFIELD
State	:	NY
Zip	:	14867-8918
Country	:	US
Telephone Number	:	607-564-9955
Fax Number	:	607-564-3624

Provider Business Practice Location Address
First Line	:	247 MAIN ST
Second Line	:
City	:	NEWFIELD
State	:	NY
Zip	:	14867-8918
Country	:	US
Telephone Number	:	607-564-9955
Fax Number	:	607-564-3624

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

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	09/27/2011

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