Individual
RAQUEL K RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
13353 OLIVE BLVD, CHESTERFIELD, MO 63017-3108
(636) 778-2900
(636) 778-2828
Mailing address
13353 OLIVE BLVD, CHESTERFIELD, MO 63017-3108
(636) 778-2900
(636) 778-2828
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2022005794
MO
Other
Enumeration date
03/30/2020
Last updated
11/17/2025
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