Individual
MS. COMONIQUE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2151 E SOUTHERN AVE APT 1082, MESA, AZ 85204-5358
(347) 581-8028
(480) 892-4991
Mailing address
2151 E SOUTHERN AVE APT 1082, MESA, AZ 85204-5358
(347) 581-8028
(480) 892-4991
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
10/09/2020
Last updated
10/09/2020
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