Individual
JA'NET RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1468 MADISON AVE, NEW YORK, NY 10029-6508
(212) 241-6500
Mailing address
PO BOX 215, MIDDLETOWN, NJ 07748-0215
(917) 756-6849
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
340455
NY
Other
Enumeration date
04/03/2021
Last updated
04/03/2021
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