Individual provider · Type 1 NPI
John Russell
Nurse Practitioner · Rockford, IL
Practice location
1340 Charles St, Suite 300
Rockford, IL 61104
Mailing address
PO Box 78866
Milwaukee, WI 53278-8866
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner | 363L00000X | 209-011657 (IL) |
| Registered Nurse | 163W00000X | 041.368559 (IL) |
| Nurse Practitioner Primary | 363L00000X | 277-000310 (IL) |
Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…
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About NPI 1104237130
John Russell's National Provider Identifier is 1104237130, issued on May 13, 2014. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Rockford, IL. The record was last updated on Nov 26, 2021.