Provider Demographics
NPI:1114691060
Name:RUSSELL, HALEY ANN (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:ANN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 OLD HARRIMAN HWY
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-2733
Mailing Address - Country:US
Mailing Address - Phone:865-898-1112
Mailing Address - Fax:
Practice Address - Street 1:2538 OLD HARRIMAN HWY
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-2733
Practice Address - Country:US
Practice Address - Phone:865-898-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide