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NPI Code Detail

MEDICARE: MAKENZIE RUSSELL

MEDICARE: MAKENZIE 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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1053268912
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAKENZIE RUSSELL
Provider Business Mailing Address
First Line : 123 HYDE AVE
Second Line :
City : NILES
State : OH
Zip : 44446-1645
Country : US
Telephone Number : 234-451-7043
Fax Number :
Provider Business Practice Location Address
First Line : 165 E PARK AVE
Second Line :
City : NILES
State : OH
Zip : 44446-2352
Country : US
Telephone Number : 330-544-8005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2026
Last Update Date : 03/11/2026

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Directions to “ MAKENZIE RUSSELL ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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