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NPI Code Detail

MEDICARE: MRS. JUDITH KAY RUSSELL GNP

MEDICARE: MRS. JUDITH KAY RUSSELL GNP
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
1163WG0600XGerontology Registered Nurse59305CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
159305OTHERCONURSING

General Provider Information

NPI Number : 1780658955
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JUDITH KAY RUSSELL GNP
Provider Business Mailing Address
First Line : 6747 XENON DR
Second Line :
City : ARVADA
State : CO
Zip : 80004-2227
Country : US
Telephone Number : 303-422-9663
Fax Number :
Provider Business Practice Location Address
First Line : 8405 W ALAMEDA AVE
Second Line :
City : LAKEWOOD
State : CO
Zip : 80226-2908
Country : US
Telephone Number : 720-974-4975
Fax Number : 720-974-4993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 07/08/2007

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