Provider Demographics
NPI:1043372097
Name:RUSSO, JILL ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:ELIZABETH
Last Name:RUSSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 S THUNDERBIRD DR
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85220
Mailing Address - Country:US
Mailing Address - Phone:480-474-1170
Mailing Address - Fax:
Practice Address - Street 1:2017 S THUNDERBIRD DR
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220
Practice Address - Country:US
Practice Address - Phone:480-474-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider