Provider Demographics
NPI:1639444052
Name:RUSSELL, ERIN RACHELLE (MSN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:RACHELLE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:RACHELLE
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5633 TYLERSVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2533
Mailing Address - Country:US
Mailing Address - Phone:513-622-9595
Mailing Address - Fax:134-437-7774
Practice Address - Street 1:5633 TYLERSVILLE RD STE B
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2533
Practice Address - Country:US
Practice Address - Phone:513-622-9595
Practice Address - Fax:134-437-7774
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.336271363LF0000X
OH13245-NP207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1639444052OtherUNSURE