MEDICARE: MIKEISHA 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1891599254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKEISHA RUSSELL

Provider Business Mailing Address
First Line	:	5745 N 35TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68111-1507
Country	:	US
Telephone Number	:	402-306-3210
Fax Number	:

Provider Business Practice Location Address
First Line	:	923 N 38TH ST APT 202
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68131-1229
Country	:	US
Telephone Number	:	402-306-3210
Fax Number	:

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

Provider Enumeration Date	:	04/03/2025
Last Update Date	:	04/03/2025

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Directions to “ MIKEISHA RUSSELL ” Practice Location

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