Provider Demographics
NPI:1659761070
Name:RUSSELL, NIKKI (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:NIKKI
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3179 APPLE RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1605
Mailing Address - Country:US
Mailing Address - Phone:202-664-4146
Mailing Address - Fax:
Practice Address - Street 1:3179 APPLE RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1605
Practice Address - Country:US
Practice Address - Phone:202-664-4146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1008722163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant