Provider Demographics
NPI:1558068916
Name:NELSON, RUSSELL JOSEPH (CPRS)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:JOSEPH
Last Name:NELSON
Suffix:
Gender:M
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 REPUBLIC ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-7016
Mailing Address - Country:US
Mailing Address - Phone:513-241-2965
Mailing Address - Fax:
Practice Address - Street 1:1526 REPUBLIC ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-7016
Practice Address - Country:US
Practice Address - Phone:513-241-2965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS003338175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist