Connie Russell

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

366691-4405 Issued in UT

Practice address

1205 E Bonner Way
Salt Lake City, UT 84117-4917

Phone

(801) 598-8337

NPI assigned

Oct 9, 2019

Last updated

Oct 15, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Claris Health PLLC

  • General Practice Physician
  • Irving, TX
  • NPI 1356797070

  UT

  Medicare reassignment NPD
• Wasatch Pediatrics, Inc

  • Pediatrics Physician
  • West Jordan, UT
  • NPI 1124102595
  NPD (past)

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

{
    "created_epoch": "1570579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1518509637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9091 S EXCALIBER WAY",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840886583",
            "telephone_number": "801-824-7406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 E BONNER WAY",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841174917",
            "telephone_number": "801-598-8337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "CONNIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-09",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "366691-4405",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "UT",
            "license": "366691-3102",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy Ann Rushton, NP
• Jack William Ruske, MD
• Lydia Russell-Frey
• Alexander Russell
• Amy Bonifay Russell, PSY. D.
• Diane R Russell, FNP
• Eric Gordon Russell, DDS
• John Mark Russell, MD
• Lauren C Russell
• Leslie S Russell, CSW

• Family Nurse Practitioner in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.