Provider Demographics
NPI:1649375981
Name:RUSSELL, JENNIFER (CPNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MARTIN LUTHER KING DR E
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3367
Mailing Address - Country:US
Mailing Address - Phone:513-861-7313
Mailing Address - Fax:
Practice Address - Street 1:400 MARTIN LUTHER KING DR E
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3367
Practice Address - Country:US
Practice Address - Phone:513-861-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN134967363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics