Angela Kristin Russ

Primary specialty

Clinical Nurse SpecialistTaxonomy code 364S00000X

License

28190806A Issued in IN

Practice address

11109 Parkview Plaza Dr
Fort Wayne, IN 46845-1701

Phone

(260) 266-2911

NPI assigned

Aug 19, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1497587224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16313 ALLEN RD",
            "city": "HARLAN",
            "state": "IN",
            "postal_code": "467439727",
            "telephone_number": "260-750-9024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701",
            "telephone_number": "260-266-2911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSS",
        "first_name": "ANGELA",
        "middle_name": "KRISTIN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "IN",
            "license": "28190806A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley Rush, LMHC
• Marcus Rush
• Dana Kathleen Rusher, M.S. CCC-SLP
• David Allen Rusk, MD
• Julia Rose Rusk
• Megan Russ, CCC, SLP
• Alaina Russell
• Ametria Russell
• Brashon Russell
• Emily Russell

• Clinical Nurse Specialist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Nurse Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; 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.