Individual
MS. RENAE ROSS RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N. R.N.F.A. CNOR
Contact information
Practice address
1030 SUFFOLK LN, CEDAR HILL, TX 75104-4112
(214) 728-0610
(972) 291-4409
Mailing address
1617 FM 876, WAXAHACHIE, TX 75167-8368
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
631327
TX
163WR0006X
Registered Nurse First Assistant
Primary
631327
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0036KE
BCBS
—
Enumeration date
08/01/2006
Last updated
06/04/2020
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