Wayne Charles Russi
Individual provider Active NPI Driver · Hildale, UT
NPI 1023975737 · NPPES record last updated Jan 6, 2026
Key facts
- NPI
- 1023975737
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 242714954 (UT)
- Practice address
- 320 N Oak St
#1967
Hildale, UT 84784-1967 - Phone
- (719) 217-1967
- NPI assigned
- Jan 6, 2026
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 242714954 | UT | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 242714954 | UT | Yes |
Addresses
Primary practice location
320 N Oak St
#1967
Hildale, UT 84784-1967
Mailing address
525 E Williams Ave
#1967
Hildale, UT 84784-1967
Phone (719) 217-1967
Other providers in Hildale, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.