Provider Demographics
NPI:1518784248
Name:RUSSELL, KATHERINE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
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 1:506 BUNGALOW WOODS DR
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:WV
Mailing Address - Zip Code:25625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:506 BUNGALOW WOODS DR
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:WV
Practice Address - Zip Code:25625
Practice Address - Country:US
Practice Address - Phone:304-687-8277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty