Individual
RUSSELL SANBORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
231 SAINT ANN DR STE 2, MANDEVILLE, LA 70471-3476
(985) 624-5410
Mailing address
67037 THACKERY ST, MANDEVILLE, LA 70471-6901
(504) 442-2199
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
229532
LA
Other
Enumeration date
09/20/2023
Last updated
09/20/2023
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