Stevnika Russell

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

043-104842 Issued in IL

Practice address

5517 N Kenmore Ave
Chicago, IL 60640-1515

Phone

(773) 275-7962

NPI assigned

Apr 28, 2018

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

Practice roles

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

• Lutheran Social Services of Illinois

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Chicago, IL
  • NPI 1932318920
  NPD (past)

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

{
    "created_epoch": "1524873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524873600000",
    "number": "1861980435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10929 S KEATING AVE APT 3N",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604536262",
            "telephone_number": "312-860-8459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5517 N KENMORE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606401515",
            "telephone_number": "773-275-7962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "STEVNIKA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-28",
        "last_updated": "2018-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IL",
            "license": "043-104842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meagan Russell
• Michael Russell
• Michael Guy Russell, LCSW
• Nicole Russell
• Sarah Russell, MA, LCPC, NCC
• Susan Renee Russell, M.D.
• Trae A Russell, RPH
• Douglas Russo, MD
• Hannah Russo
• Margaret Jean Russo, RN

• Licensed Practical Nurse in Chicago, IL
• Providers in Chicago, IL by specialty
• Licensed Practical Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.

Verify at the official NPI Registry.