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General NPI Number Information
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NPI Number | 1245953645
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Entity Type | Individual
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Provider Name | LAURA LYNN RUSSELL PROVIDER
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Gender | Female
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 09/21/2022
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Provider Practice Location Address
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Address Line | 39WEST AVENUE
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City | LUCASVILLE
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State | OH
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Zip | 45648-0448
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Country | US
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Telephone | 740-821-7308
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 448
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City | LUCASVILLE
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State | OH
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Zip | 45648-0448
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Country | US
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Telephone | 742-821-7308
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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 | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number | 0000469
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License Number State | OH
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