Individual
JULIE L. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
304 A EAST 4TH ST, ELDON, MO 65026
(573) 392-5654
(573) 392-5692
Mailing address
54 HOSPITAL DR, OSAGE BEACH, MO 65065-3050
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
108385
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
425198603
—
MO
01
—
P00030899
RAILROAD MEDICARE
MO
Enumeration date
09/20/2005
Last updated
05/05/2008
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