Provider Demographics
NPI:1134433758
Name:RUSSELL, DANIELLE L (RN)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:L
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:L
Other - Last Name:JENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5846 COUNTY ROAD J
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-1056
Mailing Address - Country:US
Mailing Address - Phone:608-437-0510
Mailing Address - Fax:
Practice Address - Street 1:1550 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:PLAIN
Practice Address - State:WI
Practice Address - Zip Code:53577-9644
Practice Address - Country:US
Practice Address - Phone:608-546-9834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI173401-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse