Individual
NOAH RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
194 MISSILE AVE, MINOT AIR FORCE BASE, ND 58705
(701) 723-5633
Mailing address
194 MISSILE AVE, MINOT AIR FORCE BASE, ND 58705
(701) 723-5633
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
363A00000X
Physician Assistant
Primary
029130
NY
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
11/28/2016
Last updated
01/16/2026
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