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Individual

GREGORY RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
APRN

Contact information

Practice address
234 GOODMAN ST, CINCINNATI, OH 45219-2364
(859) 743-1083
Mailing address
1138 CAMIN LN, WALTON, KY 41094-7506

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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