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General NPI Number Information
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NPI Number | 1891413621
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Entity Type | Individual
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Provider Name | MICHAEL RUSSELL
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Gender | Male
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 80 E SILVER ST STE 400
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City | SHARON
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State | PA
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Zip | 16146-1546
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Country | US
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Telephone | 844-456-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 4206 HOPKINS RD
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City | YOUNGSTOWN
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State | OH
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Zip | 44511-3710
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Country | US
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Telephone |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN.CNP.0031358
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN.CNP.0031358
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN.CNP.0031358
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License Number State | OH
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