Provider Demographics
NPI:1780658955
Name:RUSSELL, JUDITH KAY (GNP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:KAY
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6747 XENON DR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-2227
Mailing Address - Country:US
Mailing Address - Phone:303-422-9663
Mailing Address - Fax:
Practice Address - Street 1:8405 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2908
Practice Address - Country:US
Practice Address - Phone:720-974-4975
Practice Address - Fax:720-974-4993
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO59305163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59305OtherNURSING