| NPI | 1780828343 |
|---|---|
| Former Name | KIMBERLY SUE RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH pn109782) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH 109782) |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2009-04-27 |