Active NPI
Melinda Rochelle Russell, NP
- Nurse Practitioner
- Southfield, MI
National Provider Identifier
1548758543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 4704266784
- Practice address
- 23999 Northwestern Hwy Ste 114
Southfield, MI 48075-2578 - Phone
- (248) 278-8937
- NPI assigned
- Apr 25, 2018
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 4704266784 | MI | Primary |
Addresses
Primary practice location
23999 Northwestern Hwy Ste 114
Southfield, MI 48075-2578
Mailing address
18701 Bretton Dr
Detroit, MI 48223-1379
Phone (313) 703-9710
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4704266784 | Other | MI | NURSE PRACTITIONER |
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704266784 | MI | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524614400000",
"number": "1548758543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18701 BRETTON DR",
"city": "DETROIT",
"state": "MI",
"postal_code": "482231379",
"telephone_number": "313-703-9710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23999 NORTHWESTERN HWY STE 114",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480752578",
"telephone_number": "248-278-8937"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "MELINDA",
"middle_name": "ROCHELLE",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-25",
"last_updated": "2018-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MI",
"license": "4704266784",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NURSE PRACTITIONER",
"identifier": "4704266784",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.