# RUSSELL & GENC HEALTH AND WELLNESS CENTER CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386127751
- **Authorized official:** IMELDA T RUSSELL CRNP (PARTNER)
- **Authorized official phone:** (703) 244-4633

## Contact information

- **Practice address:** 6510 KENILWORTH AVE STE 2500, RIVERDALE, MD 20737-1346
- **Practice address phone:** (410) 997-1907
- **Mailing address:** 6510 KENILWORTH AVE STE 2500, RIVERDALE, MD 20737-1346
- **Mailing address phone:** (410) 997-1907

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 09/12/2018
- **Last updated:** 10/01/2018