Individual
WAYNE CHARLES RUSSI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
320 N OAK ST, #1967, HILDALE, UT 84784-1967
(719) 217-1967
Mailing address
525 E WILLIAMS AVE, #1967, HILDALE, UT 84784-1967
(719) 217-1967
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
242714954
UT
Other
Enumeration date
01/06/2026
Last updated
01/06/2026
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