Provider Demographics
NPI:1669368924
Name:RUSSELL, JAIME L (NP)
Entity type:Individual
Prefix:MISS
First Name:JAIME
Middle Name:L
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:41 DEHART ST APT B
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5211
Mailing Address - Country:US
Mailing Address - Phone:207-212-7675
Mailing Address - Fax:
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-971-5488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ150589002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine