Healthcare Provider Details

I. General information

NPI: 1548101173
Provider Name (Legal Business Name): EMMA KRISTINE RUSSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 E CESAR E CHAVEZ AVE
LANSING MI
48906-5457
US

IV. Provider business mailing address

4360 DELL RD APT A
LANSING MI
48911-8144
US

V. Phone/Fax

Practice location:
  • Phone: 248-890-9722
  • Fax:
Mailing address:
  • Phone: 517-574-1829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: