Individual
MS. LORI RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5238
(740) 441-8058
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5238
(740) 441-8058
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
212017
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000006923
ANTHEM BCBS
—
05
—
0067463000
—
WV
01
—
0973264
MOLINA MEDICAID #
OH
05
—
0973264
—
OH
01
—
1407877111
NPI
—
01
—
430021976
RR MEDICARE
OH
Enumeration date
07/21/2006
Last updated
10/24/2011
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