Provider Demographics
NPI:1932263548
Name:MCKUNE, RUSSELL JAMES (ATC)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:JAMES
Last Name:MCKUNE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18925 LILLIAN ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1287
Mailing Address - Country:US
Mailing Address - Phone:402-916-9477
Mailing Address - Fax:
Practice Address - Street 1:6001 DODGE ST
Practice Address - Street 2:FH 024
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68182-0014
Practice Address - Country:US
Practice Address - Phone:402-554-4997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer