Basic Information
| Provider Information | |||||||||
| NPI: | 1538310073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSSELL | ||||||||
| FirstName: | LEIGH | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | RN, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1260 MONROE AVE | ||||||||
| Address2: | SUITE 15H | ||||||||
| City: | NEW PHILADELPHIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306025339 | ||||||||
| FaxNumber: | 3306024388 | ||||||||
| Practice Location | |||||||||
| Address1: | 1260 MONROE AVE | ||||||||
| Address2: | SUITE 15H | ||||||||
| City: | NEW PHILADELPHIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306025339 | ||||||||
| FaxNumber: | 3306024388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2008 | ||||||||
| LastUpdateDate: | 10/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | 251632 | OH | Y | Nursing Service Providers | Registered Nurse | Case Management |
No ID Information.