Provider Demographics
NPI:1538986401
Name:RUSSELL, ANGEL CHARLINA
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:CHARLINA
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 1:100 STERLING RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1753
Mailing Address - Country:US
Mailing Address - Phone:304-237-7726
Mailing Address - Fax:
Practice Address - Street 1:100 STERLING RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1753
Practice Address - Country:US
Practice Address - Phone:304-237-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant