Individual
TERESA M RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(619) 532-6950
(619) 532-5501
Mailing address
3485 OLD COBBLE CT, SAN DIEGO, CA 92111-4045
(619) 532-6950
(619) 532-5501
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
14528
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0387014-21
NURSE PRACTITIONER CRED
CA
01
—
199934486
CERT. WOUND OSTOMY CARE
CA
01
—
504376
REGISTERED NURSE
CA
Enumeration date
01/26/2007
Last updated
05/15/2009
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