Individual
DONNA K RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
702 LAKEVIEW AVE, PORTSMOUTH, OH 45662-5114
(740) 353-8262
Mailing address
702 LAKEVIEW AVE, PORTSMOUTH, OH 45662-5114
(740) 353-8262
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
7304250
OH
376J00000X
Homemaker
Primary
7304250
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0246342
—
OH
Enumeration date
12/08/2020
Last updated
12/08/2020
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