Provider Demographics
NPI:1619410115
Name:RUSSELL, ONIKA (LPN)
Entity Type:Individual
Prefix:
First Name:ONIKA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 KINGS HWY
Mailing Address - Street 2:APT 5A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-6007
Mailing Address - Country:US
Mailing Address - Phone:347-967-6110
Mailing Address - Fax:
Practice Address - Street 1:5455 KINGS HWY
Practice Address - Street 2:APT 5A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-6007
Practice Address - Country:US
Practice Address - Phone:347-967-6110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10327042164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse