| 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 | Endeavor Health Medical Group |
|---|---|
| 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 |
Dr. Rachel Joy Fear, CNM Advanced Practice Midwife Medicare: Not Enrolled in Medicare Practice Location: 521 Hamilton St, Evanston, IL 60202 Phone: 217-918-9124 | |
Ms. Josephine Claire Nowak, CNM Advanced Practice Midwife Medicare: Not Enrolled in Medicare Practice Location: 2650 Ridge Ave, Evanston, IL 60201 Phone: 847-982-6710 |