Provider Demographics
NPI:1306095443
Name:RUSSELL, RAQUELLE MONIQUE
Entity type:Individual
Prefix:MRS
First Name:RAQUELLE
Middle Name:MONIQUE
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 1:6270 WHITETAIL RUN
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3182
Mailing Address - Country:US
Mailing Address - Phone:216-375-7783
Mailing Address - Fax:
Practice Address - Street 1:6270 WHITETAIL RUN
Practice Address - Street 2:
Practice Address - City:OAKWOOD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44146-3182
Practice Address - Country:US
Practice Address - Phone:440-786-8789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.294418163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse