Provider Demographics
NPI:1205993037
Name:RUSSUM, LINDA MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MARIE
Last Name:RUSSUM
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 1:2206 MORRISON LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-9725
Mailing Address - Country:US
Mailing Address - Phone:707-863-9098
Mailing Address - Fax:
Practice Address - Street 1:2206 MORRISON LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9725
Practice Address - Country:US
Practice Address - Phone:707-863-9098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA227021163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health