Individual
RUSSELL FIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3318
(573) 300-0138
Mailing address
273 SHELLY LN, POPLAR BLUFF, MO 63901-7734
(573) 300-0138
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2023036364
MO
Other
Enumeration date
01/05/2024
Last updated
01/05/2024
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