Provider Demographics
NPI:1033541081
Name:RUSS, MONIQUE YEVETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:YEVETTE
Last Name:RUSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MONIQUE
Other - Middle Name:YEVETTE
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1522 N 33RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-2301
Mailing Address - Country:US
Mailing Address - Phone:414-254-8650
Mailing Address - Fax:
Practice Address - Street 1:1522 N 33RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-2301
Practice Address - Country:US
Practice Address - Phone:414-254-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI224762-30163W00000X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)