Provider Demographics
NPI:1831573484
Name:RUSSELL, ELSHA CACHET
Entity type:Individual
Prefix:
First Name:ELSHA
Middle Name:CACHET
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 E 5350 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:WASHINGTON TERRACE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-5414
Mailing Address - Country:US
Mailing Address - Phone:801-721-4422
Mailing Address - Fax:
Practice Address - Street 1:448 E 5350 S
Practice Address - Street 2:SUITE B
Practice Address - City:WASHINGTON TERRACE
Practice Address - State:UT
Practice Address - Zip Code:84405-5414
Practice Address - Country:US
Practice Address - Phone:801-721-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT159618398246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT159618398OtherLICENSE STATE OF UT