Individual
CODY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1757 INDIAN WOOD CIR, MAUMEE, OH 43537-4009
(833) 692-9134
Mailing address
1757 INDIAN WOOD CIR, MAUMEE, OH 43537-4009
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
175775
OH
Other
Enumeration date
01/18/2021
Last updated
01/18/2021
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