Individual
AMETRIA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7209 ENGLE RD, FORT WAYNE, IN 46804-2238
(260) 484-4600
(260) 484-4002
Mailing address
7209 ENGLE RD, FORT WAYNE, IN 46804-2238
(260) 484-4600
(260) 484-4002
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
IN
Other
Enumeration date
09/13/2018
Last updated
09/13/2018
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