Marie Russell, RN, MN, C-ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

188476 Issued in NC

Practice address

7944 Birmingham Dr
San Diego, CA 92123-2705

Phone

(858) 939-4622

Fax

(858) 939-4627

NPI assigned

Mar 13, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mari Russell Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Adult Nurse Practitioner, Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351555200000",
    "number": "1154454155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6620 ANTIGUA BLVD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921244011",
            "telephone_number": "848-384-7213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7944 BIRMINGHAM DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232705",
            "telephone_number": "858-939-4622",
            "fax_number": "858-939-4627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MARIE",
        "credential": "RN, MN, C-ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-13",
        "last_updated": "2012-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "188476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARI",
            "last_name": "RUSSELL",
            "credential": "NP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jenifer Lynn Russell, RADT
• Kathryn Russell
• Kevin L. Russell, MD, MTM&H
• Kim Koehler Russell, OTR/L
• Laura Russell, LCSW
• Mary J Russell, PHYSICAL THERAPIST
• Matthew Craig Russell, M.D.
• Natasha Coriell Russell
• Ondrea Necole Russell
• Rebecca Jean Russell, LMFT

• Adult Health Nurse Practitioner in San Diego, CA
• Providers in San Diego, CA by specialty
• Adult Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.