Provider Demographics
NPI:1992300362
Name:RUSSELL, CHERISH MARYANGEL
Entity type:Individual
Prefix:MS
First Name:CHERISH
Middle Name:MARYANGEL
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 1:913 E OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-4234
Mailing Address - Country:US
Mailing Address - Phone:702-416-9028
Mailing Address - Fax:
Practice Address - Street 1:913 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-4234
Practice Address - Country:US
Practice Address - Phone:702-416-9028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1053975078Medicaid