Shelly B Russ, LPN
Individual provider Active NPI Licensed Practical Nurse · Amanda, OH
NPI 1609159243 · NPPES record last updated Sep 20, 2011
Key facts
- NPI
- 1609159243
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 144348 (OH)
- Practice address
- 6495 Julian Rd SW
Amanda, OH 43102-9527 - Phone
- (740) 969-4499
- NPI assigned
- Sep 20, 2011
- Sex
- Female
- 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 |
|---|---|---|---|
| 144348 | OH | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 144348 | OH | Yes |
Addresses
Primary practice location
6495 Julian Rd SW
Amanda, OH 43102-9527
Mailing address
6495 Julian Rd SW
Amanda, OH 43102-9527
Phone (740) 969-4499
Other providers in Amanda, OH
- Andrew Junak
- Kelly Dominic, Imft LLC
- Caullette Kilby
- Christina J Olive
- Samantha Jayne Parry
- S&Q Solutions
- Heather Schultz
- Shiane Sharp
- Ginger Lea Speakman
- Tammy Arlene Thomas
All providers in Amanda, OH · Licensed Practical Nurse in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2011. 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.