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Individual
LAINE C RUSSELL
Active
Individual
LAINE C RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
6623A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0078812
—
MT
01
—
312895
BLUE CROSS BLUE SHIELD
WY
01
—
P00140483
RAILROAD MEDICARE
WY
Enumeration date
10/13/2005
Last updated
01/02/2008
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