Individual
SARAH RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AA
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106
(216) 844-7330
(216) 844-3781
Mailing address
3605 WARRENSVILLE CENTER ROAD, 1ST FLOOR, SHAKER HTS, OH 44122
(216) 286-6260
(216) 286-6341
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
67000095
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000232320
UNISON
OH
01
—
000000521138
ANTHEM
OH
01
—
0583328
BCMH
OH
05
—
2517459
—
OH
01
—
415029
WELLCARE MEDICAID
OH
01
—
7669949
AETNA
OH
Enumeration date
08/26/2005
Last updated
06/12/2009
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