Provider Demographics
NPI:1760220214
Name:RUSSELL, CARRIE ELIZABETH
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46340 COUNTRY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-8789
Mailing Address - Country:US
Mailing Address - Phone:740-827-0718
Mailing Address - Fax:
Practice Address - Street 1:46340 COUNTRY LAKE DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8789
Practice Address - Country:US
Practice Address - Phone:740-827-0718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant