Provider Demographics
NPI:1730989054
Name:LANDRETH, RUSSELL
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:LANDRETH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NE
Mailing Address - Zip Code:68769-2113
Mailing Address - Country:US
Mailing Address - Phone:701-885-1281
Mailing Address - Fax:
Practice Address - Street 1:206 N ELM ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NE
Practice Address - Zip Code:68769-2113
Practice Address - Country:US
Practice Address - Phone:701-885-1281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide