Individual
MARY EILEEN KUMAH RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
625 N 6TH ST, PHOENIX, AZ 85004-2155
(602) 406-8222
(602) 406-7811
Mailing address
PO BOX 33269, PHOENIX, AZ 85067-3269
(602) 406-4786
(916) 636-4358
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
228209
AZ
Other
Enumeration date
06/26/2019
Last updated
03/31/2022
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