Individual
ASHLEY RENEE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1615 W RIVERSIDE AVE, MUNCIE, IN 47303
(765) 285-5178
(765) 285-8762
Mailing address
3784 N TILLOTSON AVE APT 114, MUNCIE, IN 47304-1784
(574) 327-5099
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/13/2022
Last updated
07/13/2022
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