MEDICARE: ANTUANETTE RUSSELL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	374700000X	Technician
2	171M00000X	Case Manager/Care Coordinator
3	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1972483386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTUANETTE RUSSELL

Provider Business Mailing Address
First Line	:	1320 YATES ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-2558
Country	:	US
Telephone Number	:	419-819-2726
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 YATES ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-2558
Country	:	US
Telephone Number	:	419-819-2726
Fax Number	:

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

Provider Enumeration Date	:	09/05/2025
Last Update Date	:	12/01/2025

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Directions to “ ANTUANETTE RUSSELL ” Practice Location

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