Provider Demographics
NPI:1881186971
Name:RUSSELL, THOMAS LEE (DNP, CNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEE
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:DNP, CNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 CHARLOTTE CIR
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2559
Mailing Address - Country:US
Mailing Address - Phone:419-406-0067
Mailing Address - Fax:888-728-4024
Practice Address - Street 1:17872 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MIDDLE POINT
Practice Address - State:OH
Practice Address - Zip Code:45863
Practice Address - Country:US
Practice Address - Phone:419-968-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.317795163W00000X
OHAPRN.CNP.022944363L00000X, 363LP2300X, 363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care