Provider Demographics
NPI:1225408198
Name:RUSSELL, MARJORIA (LPN,HHA)
Entity type:Individual
Prefix:
First Name:MARJORIA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LPN,HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SAVANNAH ST SE
Mailing Address - Street 2:APT E
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-5471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:255 SAVANNAH ST SE
Practice Address - Street 2:APT E
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-5471
Practice Address - Country:US
Practice Address - Phone:202-910-6553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1006794164W00000X
DCHHA11422374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No164W00000XNursing Service ProvidersLicensed Practical Nurse