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JOHN RUSSELL
Nurse Practitioner
NPI: 1104237130Individual
Specialties, Licenses & Credentials
Nurse PractitionerPrimary
Nurse Practitioner
Code: 363L00000X
209-011657(IL)277-000310(IL)
Registered Nurse
Registered Nurse
Code: 163W00000X
041.368559(IL)
Contact & Hours
- Address
- 1340 CHARLES ST, SUITE 300
ROCKFORD, IL 61104 - Phone
- (779) 696-8800
Quick Facts
- NPI
- 1104237130
- Entity Type
- Individual
- Gender
- Male
- Medicare
- Not confirmed
- Specialties
- 3
- Locations
- 1
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