Individual
MARYBETH RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
4500 W 69TH ST, SIOUX FALLS, SD 57108-8148
(605) 977-7000
(605) 977-7001
Mailing address
4500 W 69TH ST, SIOUX FALLS, SD 57108-8148
(605) 977-7000
(605) 977-7001
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
0159
SD
Other
Enumeration date
12/11/2006
Last updated
07/08/2007
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