Individual
MRS. REBECCA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4210 LAKE BOONE TRL, RALEIGH, NC 27607-6521
(919) 784-6600
Mailing address
4210 LAKE BOONE TRL, RALEIGH, NC 27607-6521
(919) 784-6600
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
5017539
NC
363LF0000X
Family Nurse Practitioner
F-338111-1
NY
Other
Enumeration date
11/08/2013
Last updated
01/23/2023
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