Individual
MRS. JAQUITUA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5005 LONGSTREET PL UNIT 1, BOSSIER CITY, LA 71112
(714) 929-6744
Mailing address
5005 LONGSTREET PL UNIT 1, BOSSIER CITY, LA 71112-4714
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/05/2016
Last updated
07/14/2018
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