Provider Demographics
NPI:1023025491
Name:RUSSELL, RENAE ROSS (RN RNFA CNOR)
Entity Type:Individual
Prefix:MS
First Name:RENAE
Middle Name:ROSS
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:RN RNFA CNOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 FM 876
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75167-8368
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1030 SUFFOLK LN
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-4112
Practice Address - Country:US
Practice Address - Phone:214-728-0610
Practice Address - Fax:972-291-4409
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX631327163W00000X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
0036KEOtherBCBS
0036KEOtherBCBS