Individual
HOLLY L RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2900 16TH ST, BEDFORD, IN 47421-3510
(812) 275-1200
Mailing address
550 S LANDMARK AVE, BLOOMINGTON, IN 47403-3239
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71007594A
IN
Other
Enumeration date
10/25/2017
Last updated
08/13/2019
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