Individual
BERNADETTE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1213 HARBOR ISLAND WALK, BALTIMORE, MD 21230-5461
(610) 209-4132
Mailing address
1213 HARBOR ISLAND WALK, BALTIMORE, MD 21230-5461
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R186183
MD
Other
Enumeration date
09/01/2015
Last updated
09/01/2015
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