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Gloria Elizabeth Russell

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

2817 Reilly St, Fort Bragg, NC 28310-7324

PECOS Enrollment

This provider is enrolled in PECOS as GLORIA RUSSELL.

Based on the most recent information from CMS, provider Gloria Elizabeth Russell is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 9:43 AM.

Profile Details

Provider ID
1720639313
Provider Type
Individual
Full Name
Russell, Gloria Elizabeth
Title
Mrs.
Credential
FNP-C

Gender
Female
Sole Proprietor
No
Enumeration Date
9/25/2019
Last Updated
4/20/2021

Contact Information

Practice Location

2817 Reilly St, Fort Bragg, NC 28310-7324

(910) 584-3674

Unlisted Fax

Mailing Location

2817 Reilly St, Fort Bragg, NC 28310-7394

(910) 907-6900

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License RUSS-0AEOR1 North Carolina

Gloria Elizabeth Russell

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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