Individual
DR. PATRICK KELLY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNAP, CRNA
Contact information
Practice address
1 BAY AVE, MONTCLAIR, NJ 07042-4837
(973) 429-6000
Mailing address
157 CLARKEN DR, WEST ORANGE, NJ 07052-3429
(619) 675-4910
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
26NJ01401400
NJ
367500000X
Certified Registered Nurse Anesthetist
95001877
CA
Other
Enumeration date
12/05/2022
Last updated
12/05/2022
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