Individual
TYLER WILLIAM RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 577-4200
(317) 577-9503
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
28211638A
IN
367500000X
Certified Registered Nurse Anesthetist
202206135CRNA
OR
367500000X
Certified Registered Nurse Anesthetist
28211638A
IN
Other
Enumeration date
04/02/2020
Last updated
10/19/2022
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