Individual
LISA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LM
Contact information
Practice address
4222 MCINTOSH LN, SARASOTA, FL 34232-5027
(941) 366-2229
Mailing address
4222 MCINTOSH LN, SARASOTA, FL 34232-5027
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
MW333
FL
Other
Enumeration date
07/20/2016
Last updated
07/20/2016
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