Provider Demographics
NPI:1508957556
Name:RUSSELL, JUDITH ANITA
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANITA
Last Name:RUSSELL
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 1:1001 S MARSHALL ST
Mailing Address - Street 2:BOX 81
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5852
Mailing Address - Country:US
Mailing Address - Phone:336-722-4777
Mailing Address - Fax:336-722-0097
Practice Address - Street 1:1001 S MARSHALL ST
Practice Address - Street 2:BOX 81
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5852
Practice Address - Country:US
Practice Address - Phone:336-722-4777
Practice Address - Fax:336-722-0097
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2988374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered374U00000XNursing Service Related ProvidersHome Health Aide
Not Answered376K00000XNursing Service Related ProvidersNurse's Aide