Provider Demographics
NPI:1497858070
Name:RUSSELL, JACQUELINE MARIE (RN MSN APNC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MARIE
Last Name:RUSSELL
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Gender:F
Credentials:RN MSN APNC
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Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-0593
Mailing Address - Country:US
Mailing Address - Phone:609-463-2755
Mailing Address - Fax:609-463-2757
Practice Address - Street 1:4011 ROUTE 9 S
Practice Address - Street 2:SUITE 201
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242-1916
Practice Address - Country:US
Practice Address - Phone:609-770-7788
Practice Address - Fax:609-770-7774
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-02-22
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Provider Licenses
StateLicense IDTaxonomies
NJ26NN06637900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q01515Medicare UPIN