Provider Demographics
NPI:1942959507
Name:BROWN, RUSSON (BSN RN)
Entity Type:Individual
Prefix:
First Name:RUSSON
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:BSN RN
Other - Prefix:
Other - First Name:RUSS
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN RN
Mailing Address - Street 1:4444 CASA GRANDE CIR APT 70
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2552
Mailing Address - Country:US
Mailing Address - Phone:630-429-3132
Mailing Address - Fax:
Practice Address - Street 1:23700 CAMINO DEL SOL
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5017
Practice Address - Country:US
Practice Address - Phone:310-784-2217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95203527163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty