John Russell

NPI #1104237130 in Rockford, Illinois

Provider Information

NPI Number: 1104237130
Entity Type: Individual
Name: John Russell
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Nurse Practitioner
Enumeration Date: May 13, 2014
Last Updated: Nov 26, 2021

Practice Location

Address: 1340 CHARLES ST
Address 2: SUITE 300
City: Rockford
State: Illinois
ZIP Code: 61104
Phone: (779) 696-8800

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nurse Practitioner	363L00000X	Primary
Registered Nurse	163W00000X

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