Gina M Russano, APN-CNM | |
2650 Ridge Ave Ste 1420, Evanston, IL 60201-1700 | |
(847) 570-2860 | |
(847) 733-5087 |
Full Name | Gina M Russano |
---|---|
Gender | Female |
Speciality | Advanced Practice Midwife |
Location | 2650 Ridge Ave Ste 1420, Evanston, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1982654422 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
163W00000X | Registered Nurse | 041195067 (Illinois) | Secondary |
367A00000X | Advanced Practice Midwife | 209-003034 (Illinois) | Primary |
Entity Name | Northshore University Healthsystem Faculty Practice Associates |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1497701882 PECOS PAC ID: 2163334699 Enrollment ID: O20040524000118 |
Mailing Address | Practice Location Address |
---|---|
Gina M Russano, APN-CNM 2650 Ridge Ave Ste 1420, Evanston, IL 60201-1700 Ph: (847) 570-2860 | Gina M Russano, APN-CNM 2650 Ridge Ave Ste 1420, Evanston, IL 60201-1700 Ph: (847) 570-2860 |
Gaye Desiree Koconis, CNM Advanced Practice Midwife Medicare: Not Enrolled in Medicare Practice Location: 2500 Ridge Ave, Evanston, IL 60201 Phone: 847-475-1224 | |
Mrs. Debora J Lesnick, CNM Advanced Practice Midwife Medicare: Not Enrolled in Medicare Practice Location: 2500 Ridge Ave, Suite 301, Evanston, IL 60201 Phone: 847-475-1224 Fax: 847-475-0150 |