MEDICARE: HANNAH 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1346950888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH RUSSELL

Provider Business Mailing Address
First Line	:	1834 HACKWORTH HILL RD UNIT B
Second Line	:
City	:	OTWAY
State	:	OH
Zip	:	45657-8001
Country	:	US
Telephone Number	:	740-285-7075
Fax Number	:

Provider Business Practice Location Address
First Line	:	2364 HACKWORTH HILL RD
Second Line	:
City	:	OTWAY
State	:	OH
Zip	:	45657-9029
Country	:	US
Telephone Number	:	740-285-7075
Fax Number	:

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

Provider Enumeration Date	:	11/23/2022
Last Update Date	:	11/23/2022

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Directions to “ HANNAH RUSSELL ” Practice Location

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