Individual
MARIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MN, C-ANP
Contact information
Practice address
7944 BIRMINGHAM DR, SAN DIEGO, CA 92123-2705
(858) 939-4622
(858) 939-4627
Mailing address
6620 ANTIGUA BLVD, SAN DIEGO, CA 92124-4011
(848) 384-7213
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
188476
NC
Other
Enumeration date
03/13/2007
Last updated
10/30/2012
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