Healthcare Provider Details

I. General information

NPI: 1245864248
Provider Name (Legal Business Name): DORSHALLE FORREST-RUSSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 DARTMOUTH AVE
COLUMBUS OH
43219-2646
US

IV. Provider business mailing address

2235 DARTMOUTH AVE
COLUMBUS OH
43219-2646
US

V. Phone/Fax

Practice location:
  • Phone: 614-348-5969
  • Fax:
Mailing address:
  • Phone: 614-348-5969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: