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General NPI Number Information
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NPI Number | 1538483516
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Entity Type | Individual
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Provider Name | CAITLYN RUSSELL AD OF NURSING
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Gender | Female
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Dates
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Enumeration Date | 03/20/2010
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Last Update Date | 03/20/2010
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Provider Practice Location Address
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Address Line | 60 FOREST PARK DR APT. D
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City | HAMILTON
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State | OH
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Zip | 45011-0834
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Country | US
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Telephone | 513-253-2454
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Fax |
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Provider Business Mailing Address
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Address Line | 60 FOREST PARK DR APT. D
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City | HAMILTON
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State | OH
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Zip | 45011-0834
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Country | US
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Telephone | 513-253-2454
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 358321
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License Number State | OH
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