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General NPI Number Information
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NPI Number | 1023975737
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Entity Type | Individual
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Provider Name | WAYNE CHARLES RUSSI
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Gender | Male
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 320 N OAK ST #1967
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City | HILDALE
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State | UT
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Zip | 84784-1967
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Country | US
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Telephone | 719-217-1967
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Fax |
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Provider Business Mailing Address
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Address Line | 525 E WILLIAMS AVE #1967
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City | HILDALE
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State | UT
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Zip | 84784-1967
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Country | US
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Telephone | 719-217-1967
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | 242714954
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License Number State | UT
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