MEDICARE: SARAH RUSSELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1538755004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH RUSSELL

Provider Business Mailing Address
First Line	:	410 S RAMPART BLVD STE 390
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5749
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 E WYOMING AVE SPC 442
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-4944
Country	:	US
Telephone Number	:	775-513-1355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2020
Last Update Date	:	12/17/2020

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Directions to “ SARAH RUSSELL ” Practice Location

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