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NPI Code Detail

MEDICARE: NICOLE RUSSELL

MEDICARE: NICOLE RUSSELL
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
1106S00000XBehavior TechnicianRBT-25-488907AZ

General Provider Information

NPI Number : 1922951441
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE RUSSELL
Provider Business Mailing Address
First Line : PO BOX 740780
Second Line :
City : ATLANTA
State : GA
Zip : 30374-0780
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Provider Business Practice Location Address
First Line : 1519 S HIGLEY RD
Second Line :
City : GILBERT
State : AZ
Zip : 85296-4793
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2026
Last Update Date : 02/16/2026

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Directions to “ NICOLE RUSSELL ” Practice Location

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