Healthcare Provider Details

I. General information

NPI: 1154241495
Provider Name (Legal Business Name): ERIKA JOAN RUSSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14823 STATE ROUTE 30
MALONE NY
12953-4815
US

IV. Provider business mailing address

324 COUNTY ROUTE 51 BLDG 1
MALONE NY
12953-4502
US

V. Phone/Fax

Practice location:
  • Phone: 518-521-3856
  • Fax: 518-481-1108
Mailing address:
  • Phone: 518-483-1251
  • Fax: 518-483-2242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number330051
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: