Healthcare Provider Details

I. General information

NPI: 1568905180
Provider Name (Legal Business Name): ALISHA RUSSELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BRADY AVE
STEUBENVILLE OH
43952-1459
US

IV. Provider business mailing address

302 W MAIN ST
SAINT CLAIRSVILLE OH
43950-8801
US

V. Phone/Fax

Practice location:
  • Phone: 740-282-4231
  • Fax:
Mailing address:
  • Phone: 740-968-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number330508
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: