Most Relevant Information
Provider Data
| NPI Number: | 1003495516 |
| Provider Name: | JA'NET RUSSELL |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | 340455 |
Most Important Dates
| Enumeration Date: | 04/03/2021 |
| Last Updated: | 04/03/2021 |
Provider Practice Location
1468 MADISON AVE
NEW YORK
NY
100296508
Practice Location Phone/Fax
| Phone: | 2122416500 |
| Fax: |
Provider Mailing Location
PO BOX 215
MIDDLETOWN
NJ
077480215
Provider Mailing Phone/Fax
| Phone: | 9177566849 |
| Fax: |