Provider Demographics
NPI:1457527335
Name:RUSSELL, DEBORAH L (LPN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 GARMEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:NY
Mailing Address - Zip Code:13420-0056
Mailing Address - Country:US
Mailing Address - Phone:315-369-5335
Mailing Address - Fax:
Practice Address - Street 1:191 GARMEN AVE
Practice Address - Street 2:DEBORAH L RUSSELL
Practice Address - City:OLD FORGE
Practice Address - State:NY
Practice Address - Zip Code:13420-0056
Practice Address - Country:US
Practice Address - Phone:315-369-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273629164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse