Provider Demographics
NPI:1689933152
Name:RUSSELL, ANDREW W (HIS)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:W
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3188
Mailing Address - Country:US
Mailing Address - Phone:603-893-2361
Mailing Address - Fax:603-893-2780
Practice Address - Street 1:224 MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3188
Practice Address - Country:US
Practice Address - Phone:603-893-2361
Practice Address - Fax:603-893-2780
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHH597237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist