Individual
MR. REGINALD TAYLOR RUSSELL II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1919 COMMERCE DR, HAMPTON, VA 23666-4269
(757) 223-0500
Mailing address
104 ROCKLAND TER, SUFFOLK, VA 23434-2053
(804) 304-4884
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
2008010430
VA
286500000X
Military Hospital
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024178243
VA
Other
Enumeration date
05/11/2009
Last updated
04/04/2023
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