Healthcare Provider Details

I. General information

NPI: 1922939933
Provider Name (Legal Business Name): LETISHA DENISE RUSSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10910 ASHBURY AVE
CLEVELAND OH
44106-1842
US

IV. Provider business mailing address

10910 ASHBURY AVE
CLEVELAND OH
44106-1842
US

V. Phone/Fax

Practice location:
  • Phone: 216-804-1700
  • Fax:
Mailing address:
  • Phone: 216-804-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400711580108
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: