Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 57.250887 | OH |
NPI | 1003494568 |
---|---|
Provider Name | Melanie Russell |
First Address | Cincinnati, OH 45267-0001 |
Second Address | Cincinnati, OH 45219-2364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2021 |
Last Update Date | 28/06/2021 |