Individual
ANIYAH NICOLE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1670 CLAIRMONT RD, DECATUR, GA 30033-4004
(404) 321-6111
Mailing address
3418 TABLE ROCK DR, GASTONIA, NC 28052-5436
(704) 606-0501
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
357577
NC
Other
Enumeration date
08/22/2024
Last updated
08/22/2024
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