Provider Demographics
NPI:1184310559
Name:RUSSELL, MICHELLE LYNN (DO)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BEECHWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:PA
Mailing Address - Zip Code:16143-9302
Mailing Address - Country:US
Mailing Address - Phone:724-714-7625
Mailing Address - Fax:
Practice Address - Street 1:800 PENNSYLVANIA AVENUE
Practice Address - Street 2:CHILDREN'S MEDICINE CENTER
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302
Practice Address - Country:US
Practice Address - Phone:304-414-1880
Practice Address - Fax:304-414-1886
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program