Individual
KADIAN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
433 SILAS DEANE HWY STE 2, WETHERSFIELD, CT 06109-2123
(860) 595-7585
Mailing address
47 ASHLEY CT, BLOOMFIELD, CT 06002-1798
(860) 595-7585
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
079829
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87-1036488
PRIVATE PAY
CT
Enumeration date
11/24/2021
Last updated
11/24/2021
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