Active NPI
Amy Russell
- Licensed Practical Nurse
- Gary, IN
National Provider Identifier
1184186397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 27056440A
- Practice address
- 1100 W 6TH Ave
Gary, IN 46402-1711 - Phone
- (219) 885-4264
- NPI assigned
- Apr 5, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 27056440A | IN | Primary |
Addresses
Primary practice location
1100 W 6TH Ave
Gary, IN 46402-1711
Mailing address
2730 New Hampshire St
Lake Station, IN 46405-1346
Phone (219) 671-6187
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27056440A | IN | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554422400000",
"number": "1184186397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2730 NEW HAMPSHIRE ST",
"city": "LAKE STATION",
"state": "IN",
"postal_code": "464051346",
"telephone_number": "219-671-6187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 W 6TH AVE",
"city": "GARY",
"state": "IN",
"postal_code": "464021711",
"telephone_number": "219-885-4264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "AMY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-05",
"last_updated": "2019-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "IN",
"license": "27056440A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gary, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.