Individual ProviderJudith D RussellRegistered NurseNursing Service ProvidersPractice Address4740 N Clark St, Chicago, IL 60640-4689(773) 769-0205PECOS EnrollmentBased on the most recent information from CMS, provider Judith D Russell does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1649770827Provider TypeIndividualFull NameRussell, Judith DCredentialRNGenderFemaleSole ProprietorYesEnumeration Date2/14/2018Last Updated2/14/2018Contact InformationPractice LocationPractice Address4740 N Clark St, Chicago, IL 60640-4689Phone(773) 769-0205FaxUnlisted FaxMailing LocationMailing Address1517 Mulford St, Evanston, IL 60202-3231PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode163W00000XPrimaryDescriptionRegistered NurseNursing Service ProvidersLicense041.272512Illinois