MEDICARE: CANDICE 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	163W00000X	Registered Nurse	420146	OH

General Provider Information

NPI Number	:	1861350365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE RUSSELL

Provider Business Mailing Address
First Line	:	16761 SAINT CLAIR AVE
Second Line	:
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-9400
Country	:	US
Telephone Number	:	330-932-1823
Fax Number	:

Provider Business Practice Location Address
First Line	:	16761 SAINT CLAIR AVE
Second Line	:
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-9400
Country	:	US
Telephone Number	:	330-932-1823
Fax Number	:

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

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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Directions to “ CANDICE RUSSELL ” Practice Location

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