Individual
TAMIKA JEAN RUSSAVAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1807 S 60TH ST, OMAHA, NE 68106-2151
(531) 299-1080
(531) 299-1099
Mailing address
14568 CORBY ST, OMAHA, NE 68116-5104
(402) 334-8369
(531) 299-1099
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
69653
NE
163WS0200X
School Registered Nurse
Primary
69653
NE
Other
Enumeration date
10/18/2024
Last updated
10/18/2024
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