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General NPI Number Information
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NPI Number | 1023838323
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Entity Type | Individual
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Provider Name | COURTNEY RUSSO
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Gender | Female
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Dates
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Enumeration Date | 10/12/2024
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Last Update Date | 10/12/2024
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Provider Practice Location Address
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Address Line | 2226 MORRIS AVE NE
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City | CANTON
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State | OH
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Zip | 44705-3466
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Country | US
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Telephone | 330-313-6503
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Fax |
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Provider Business Mailing Address
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Address Line | 8050 STUHLDREHER ST NW APT 4
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City | MASSILLON
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State | OH
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Zip | 44646-1977
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Country | US
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Telephone | 330-316-5532
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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