Provider Demographics
NPI:1740726298
Name:RUSSELL, JUANITA (SCHOOL NURSE)
Entity type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:SCHOOL NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 JUNEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45218-1229
Mailing Address - Country:US
Mailing Address - Phone:513-619-2390
Mailing Address - Fax:513-619-2398
Practice Address - Street 1:73 JUNEFIELD AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45218-1229
Practice Address - Country:US
Practice Address - Phone:513-619-2390
Practice Address - Fax:513-619-2398
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN106463164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse