Individual
MRS. BRIDGET RENA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BS
Contact information
Practice address
4000 JENNINGS STATION RD, SAINT LOUIS, MO 63121-3323
(314) 679-7916
(314) 679-7876
Mailing address
4000 JENNINGS STATION RD, SAINT LOUIS, MO 63121-3323
(314) 679-7916
(314) 679-7876
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
2003027751
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103-4879
EMPLOYEE IDENITIFCATION #
MO
Enumeration date
12/11/2006
Last updated
07/08/2007
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