Provider Demographics
NPI:1699148163
Name:RUSSELL, RACHELLE
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
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:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IL
Mailing Address - Zip Code:62060-0025
Mailing Address - Country:US
Mailing Address - Phone:618-402-6818
Mailing Address - Fax:
Practice Address - Street 1:1915 RHODES ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IL
Practice Address - Zip Code:62060-1355
Practice Address - Country:US
Practice Address - Phone:618-402-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other