Healthcare Provider Details

I. General information

NPI: 1558639831
Provider Name (Legal Business Name): NANCY ELLEN RUSSELL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 03/12/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 BABSON PLACE SUITE 600
CINCINNATI OH
45227
US

IV. Provider business mailing address

4900 BABSON PL
CINCINNATI OH
45227-2693
US

V. Phone/Fax

Practice location:
  • Phone: 513-272-8444
  • Fax: 513-272-0015
Mailing address:
  • Phone: 513-272-8444
  • Fax: 513-272-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number16812
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN180312
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: