Provider Demographics
NPI:1598649337
Name:RUSSELL, MOIESHEY LAMIE
Entity type:Individual
Prefix:
First Name:MOIESHEY
Middle Name:LAMIE
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 1:5825 LARRY WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-4414
Mailing Address - Country:US
Mailing Address - Phone:415-577-0411
Mailing Address - Fax:
Practice Address - Street 1:2202 PLAZA DR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4404
Practice Address - Country:US
Practice Address - Phone:916-749-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician