Provider Demographics
NPI:1770866691
Name:RUSSELL, KAREN LEAH (RN)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LEAH
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14867-8918
Mailing Address - Country:US
Mailing Address - Phone:607-564-9955
Mailing Address - Fax:607-564-3624
Practice Address - Street 1:247 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWFIELD
Practice Address - State:NY
Practice Address - Zip Code:14867-8918
Practice Address - Country:US
Practice Address - Phone:607-564-9955
Practice Address - Fax:607-564-3624
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278191-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool