Individual
GREGORY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
163WF0300X
Flight Registered Nurse
RN.365577
OH
363L00000X
Nurse Practitioner
Primary
025098
OH
363LA2100X
Acute Care Nurse Practitioner
APRN.CNP.025098
OH
Other
Enumeration date
03/02/2019
Last updated
07/22/2019
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