Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

John Russell

Individual provider Nurse Practitioner · NPI 1104237130

John Russell is a Nurse Practitioner in Rockford, Illinois. Licensed in Illinois. Registered with an NPI since 2014.

Licensed in
IL
In the registry since
2014
Specialties on file
3

Practice location Address checks out

1340 Charles St Ste 300
Rockford, IL 61104
Phone: (779) 696-8800
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 277-000310 (IL)
Nurse Practitioner Taxonomy 363L00000X · Licence 209-011657 (IL)
Registered Nurse Taxonomy 163W00000X · Licence 041.368559 (IL)

Record details

NPI number1104237130
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 13, 2014
Last updated in NPPESNovember 26, 2021
Certification dateNovember 26, 2021
Mailing addressPo Box 78866, Milwaukee, WI 53278-8866

Other providers in Rockford