Provider Demographics
NPI:1487776415
Name:RUSSELL, MONICA L (CNP)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-4277
Mailing Address - Country:US
Mailing Address - Phone:740-815-6024
Mailing Address - Fax:
Practice Address - Street 1:6810 PERIMETER DR
Practice Address - Street 2:CENTER SUITE 100
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8047
Practice Address - Country:US
Practice Address - Phone:614-798-1814
Practice Address - Fax:614-210-8234
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08635363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health