Individual
MRS. ANGELA RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5604
(912) 435-5680
Mailing address
1831 LAWNWOODS DR, HINESVILLE, GA 31313-9481
(912) 435-6022
(912) 370-6106
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN060765
GA
Other
Enumeration date
10/27/2005
Last updated
07/08/2007
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