Provider Demographics
NPI:1568415909
Name:RUSSELL, KAREN J (NP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:J
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:640 S STATE ST
Mailing Address - Street 2:742 BUILDING
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-674-3970
Mailing Address - Fax:302-672-2350
Practice Address - Street 1:1100 FORREST AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3309
Practice Address - Country:US
Practice Address - Phone:302-672-4600
Practice Address - Fax:302-672-4606
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000540363LF0000X
DELZ0000110363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1568415909Medicaid
DE020010C16Medicare PIN