Individual
AMANDA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13855 COURTHOUSE RD, DINWIDDIE, VA 23841-2254
(804) 469-3731
Mailing address
13855 COURTHOUSE RD, DINWIDDIE, VA 23841-2254
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101264538
VA
Other
Enumeration date
04/05/2015
Last updated
07/15/2024
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