Provider Demographics
NPI:1154122554
Name:RUSS, ANTOINETTE RAE
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:RAE
Last Name:RUSS
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 1:2213 MIAMI ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110-2124
Mailing Address - Country:US
Mailing Address - Phone:402-813-4029
Mailing Address - Fax:
Practice Address - Street 1:2213 MIAMI ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68110-2124
Practice Address - Country:US
Practice Address - Phone:402-813-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide