Provider Demographics
NPI:1780175604
Name:RUSSELL, VALERIE LONG
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:LONG
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 1:5744 ALLISON RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27311-9038
Mailing Address - Country:US
Mailing Address - Phone:336-514-2080
Mailing Address - Fax:
Practice Address - Street 1:5744 ALLISON RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NC
Practice Address - Zip Code:27311-9038
Practice Address - Country:US
Practice Address - Phone:336-514-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)