Russell, Kenneth Lee
Russell, Kenneth Lee is an sole proprietor health care provider with primary practice located at 3D Marine Raider Battalion , Camp Lejeune NC 28546. He recently has only one registered license in Other Service Providers / Independent Duty Corpsman, which is considered as his primary health care specialty. Russell, Kenneth Lee can be contacted via phone (360) 808-1590.Contact Information
Primary practice address
3D Marine Raider Battalion
Camp Lejeune NC 28546
Phone: (360) 808-1590
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Independent Duty Corpsman | 1710I1002X |
Profile Details
| NPI number | 1639661192 |
|---|---|
| LBN Legal business name | Russell, Kenneth Lee |
| Credentials | NAVY SOIDC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 31st, 2018 |
| Last updated | May 31st, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639661192 | NPPES |
| Other | 1391428740 | NAVY/DOD |
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