Individual
TIYANNA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1026 A AVE NE, CEDAR RAPIDS, IA 52402-5036
(319) 369-7211
Mailing address
1026 A AVE NE, CEDAR RAPIDS, IA 52402-5036
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
124169
IA
Other
Enumeration date
07/26/2022
Last updated
02/06/2024
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