Individual
TOSHIA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
579 NORTH HIGHWAY J, HAYTI, MO 63851
(573) 359-9840
Mailing address
579 NORTH HIGHWAY J, HAYTI, MO 63851
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2009032189
MO
Other
Enumeration date
10/08/2014
Last updated
10/08/2014
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