Provider Demographics
NPI:1760813901
Name:MOORE-RUSSELL, RUTH (CNA)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:MOORE-RUSSELL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18086 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1306
Mailing Address - Country:US
Mailing Address - Phone:313-303-1930
Mailing Address - Fax:
Practice Address - Street 1:19855 OUTER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2022
Practice Address - Country:US
Practice Address - Phone:313-274-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator