Provider Demographics
NPI:1164721700
Name:NAMANNY, RUSSELL KAYAH (BA)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:KAYAH
Last Name:NAMANNY
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 CATHY LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7591
Mailing Address - Country:US
Mailing Address - Phone:702-576-6801
Mailing Address - Fax:
Practice Address - Street 1:768 CATHY LN
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7591
Practice Address - Country:US
Practice Address - Phone:702-576-6801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner