Individual
JORDAN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4705 OLD POST RD, CHARLESTOWN, RI 02813-1841
(401) 364-7705
Mailing address
426 CENTRAL AVE, JOHNSTON, RI 02919-4710
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN62343
RI
Other
Enumeration date
12/07/2020
Last updated
12/07/2020
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