Provider Demographics
NPI:1891447934
Name:RUSSELL, CRISTINA LATOYA (RN)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:LATOYA
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-1529
Mailing Address - Country:US
Mailing Address - Phone:347-235-7817
Mailing Address - Fax:
Practice Address - Street 1:72 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-1529
Practice Address - Country:US
Practice Address - Phone:347-235-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT131575163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control