Provider Demographics
NPI:1578357786
Name:RUSSELL, STEVEN LEE
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LEE
Last Name:RUSSELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39602 HARVEY LN
Mailing Address - Street 2:
Mailing Address - City:WILKESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45695-8905
Mailing Address - Country:US
Mailing Address - Phone:740-988-0429
Mailing Address - Fax:
Practice Address - Street 1:39602 HARVEY LN
Practice Address - Street 2:
Practice Address - City:WILKESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45695-8905
Practice Address - Country:US
Practice Address - Phone:740-988-0429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUQ745009376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty