Active NPI
Antoinette Russell
- Paramedic
- Lakeside, AZ
National Provider Identifier
1457743916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Paramedic
- License
- 111
- Practice address
- 2922 W White Mountain Blvd
Lakeside, AZ 85929-6152 - Phone
- (928) 368-6112
- Fax
- (928) 368-5643
- NPI assigned
- Feb 20, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Paramedic | 146L00000X | 111 | AZ | Primary |
| Basic Emergency Medical Technician | 146N00000X | 111 | AZ |
Addresses
Primary practice location
2922 W White Mountain Blvd
Lakeside, AZ 85929-6152
Mailing address
2922 W White Mountain Blvd
Lakeside, AZ 85929-6152
Phone (928) 368-6112
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 |
|---|---|---|---|
| 111 | AZ | MD | Basic Emergency Medical Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424390400000",
"number": "1457743916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2922 W WHITE MOUNTAIN BLVD",
"city": "LAKESIDE",
"state": "AZ",
"postal_code": "859296152",
"telephone_number": "928-368-6112",
"fax_number": "928-368-5643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2922 W WHITE MOUNTAIN BLVD",
"city": "LAKESIDE",
"state": "AZ",
"postal_code": "859296152",
"telephone_number": "928-368-6112",
"fax_number": "928-368-5643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "ANTOINETTE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-02-20",
"last_updated": "2015-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "146L00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Paramedic",
"state": "AZ",
"license": "111",
"primary": true
},
{
"code": "146N00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Basic",
"state": "AZ",
"license": "111",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakeside, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.