Mary Monica Russell, LRD, CDE

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

151 Issued in ND

Practice address

1702 East Rose Creek Parkway South
Fargo, ND 58104-6834

Phone

(701) 239-4946

NPI assigned

Nov 11, 2009

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

Other names 1

• Mary Monica Blaine Former name

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": "1257897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257897600000",
    "number": "1912234071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "LANDSTUHL REGIONAL MEDICAL CENTER",
            "address_2": "CMR 402",
            "city": "APO",
            "state": "AE",
            "postal_code": "09180",
            "telephone_number": "0114915221310207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 EAST ROSE CREEK PARKWAY SOUTH",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581046834",
            "telephone_number": "701-239-4946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "MARY",
        "middle_name": "MONICA",
        "name_prefix": "Mrs.",
        "credential": "LRD, CDE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-11",
        "last_updated": "2009-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ND",
            "license": "151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "BLAINE",
            "middle_name": "MONICA",
            "credential": "RD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cydney Judith Runsvold, RPH
• Mark A Runyan, DDS
• Ashley Marie Rupp
• Laura Rupp, DNP, APRN, FNP-C
• Howard L Russell, MD
• Tanya Russiff, MSN, RN
• Allyson Rust, LPCC
• Lacey D Rust, MS OTR/L
• Sarah Ann Rustad, PHARM. D
• Madeline Frei Rustvang, RBT

• Registered Dietitian in Fargo, ND
• Providers in Fargo, ND by specialty
• Registered Dietitian in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2009; 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.