Healthcare Provider Details

I. General information

NPI: 1902674757
Provider Name (Legal Business Name): TAYLOR L RUSSELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVE
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2139 AUBURN AVE # 4-7
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-564-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0028230
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: