Individual
DESIREE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8 N SPRING ST, BUCKHANNON, WV 26201-2720
(304) 472-0395
(304) 471-2488
Mailing address
4041 HEASTON RIDGE RD, CRAWFORD, WV 26343-8532
(304) 517-3351
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
11/29/2022
Last updated
11/29/2022
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