Individual
AMORETTE D RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
625 S NEW BALLAS RD, SUITE R-7040, SAINT LOUIS, MO 63141-8232
(314) 251-6970
(314) 251-1053
Mailing address
625 S NEW BALLAS RD, SUITE R-7040, SAINT LOUIS, MO 63141-8232
(314) 251-6970
(314) 251-1053
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2003025349
MO
Other
Enumeration date
02/03/2006
Last updated
07/08/2007
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