Individual
BLAKE JAMES RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 E MCDOWELL RD, PHOENIX, AZ 85006-2612
(602) 839-2000
Mailing address
390 W WISTERIA PL, CHANDLER, AZ 85248-4031
(208) 305-3779
(208) 305-3779
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
12458171-3102
UT
367500000X
Certified Registered Nurse Anesthetist
Primary
340170
AZ
Other
Enumeration date
05/18/2026
Last updated
06/04/2026
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