Individual
MRS. EILEEN AVIS RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
HWY 160/163 BUILDING KA 2010, KAYENTA, AZ 86033-0368
(928) 697-4100
(928) 697-4029
Mailing address
PO BOX 368, KAYENTA, AZ 86033-0368
(928) 697-4100
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN071967
AZ
163WE0003X
Emergency Registered Nurse
RN071967
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060012
—
AZ
Enumeration date
04/01/2009
Last updated
04/07/2009
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