Individual
CHIQUITTA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1115 E 114TH ST, CLEVELAND, OH 44108-3744
(216) 322-3909
Mailing address
1115 E 114TH ST, CLEVELAND, OH 44108-3744
(216) 322-3909
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN.156458.MEDS-IV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0407914
—
OH
01
—
1831631
GYPSY'S ANGELS HOME HEALTH CARE LLC
OH
01
—
1831631
DODD
—
Enumeration date
03/08/2018
Last updated
11/13/2020
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