MEDICARE: JANICE A RUSSELL NP

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	5101010614	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922177377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE A RUSSELL NP

Provider Business Mailing Address
First Line	:	PO BOX 670
Second Line	:
City	:	CARSON CITY
State	:	MI
Zip	:	48811-0670
Country	:	US
Telephone Number	:	989-584-3107
Fax Number	:	989-584-6458

Provider Business Practice Location Address
First Line	:	401 E ELM ST
Second Line	:
City	:	CARSON CITY
State	:	MI
Zip	:	48811-0670
Country	:	US
Telephone Number	:	989-584-3107
Fax Number	:	989-584-6458

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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Directions to “ JANICE A RUSSELL NP” Practice Location

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