Provider Demographics
NPI:1558830786
Name:RUSS, ZETTA
Entity Type:Individual
Prefix:
First Name:ZETTA
Middle Name:
Last Name:RUSS
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 1:6021 FIDDLER RIDGE TRL UNIT 103
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-1427
Mailing Address - Country:US
Mailing Address - Phone:702-475-2591
Mailing Address - Fax:
Practice Address - Street 1:6021 FIDDLER RIDGE TRL UNIT 103
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-1427
Practice Address - Country:US
Practice Address - Phone:702-475-2591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty