Provider Demographics
NPI:1992579171
Name:RUSSELL, ASHLEIGH SUZNNE
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:SUZNNE
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 1:210 S SENECA AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-4026
Mailing Address - Country:US
Mailing Address - Phone:918-801-1272
Mailing Address - Fax:
Practice Address - Street 1:210 S SENECA AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-4026
Practice Address - Country:US
Practice Address - Phone:918-801-1272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist