MEDICARE: KAREN REGINA RUSSELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1033953161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN REGINA RUSSELL

Provider Business Mailing Address
First Line	:	1537 S CHAMPION AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-1305
Country	:	US
Telephone Number	:	614-778-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 N CASSADY AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-1512
Country	:	US
Telephone Number	:	614-967-9348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	06/25/2024

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