Provider Demographics
NPI:1538310073
Name:RUSSELL, LEIGH ANN (RN, CDE)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 MONROE AVE
Mailing Address - Street 2:SUITE 15H
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663
Mailing Address - Country:US
Mailing Address - Phone:330-602-5339
Mailing Address - Fax:330-602-4388
Practice Address - Street 1:1260 MONROE AVE
Practice Address - Street 2:SUITE 15H
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663
Practice Address - Country:US
Practice Address - Phone:330-602-5339
Practice Address - Fax:330-602-4388
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251632163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management