Individual
MISS HEATHER MARIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1010 MONONGALIA AVE SW, WILLMAR, MN 56201-3172
(320) 235-0796
Mailing address
1010 MONONGALIA AVE SW, WILLMAR, MN 56201-3172
(320) 235-0796
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R 200242-0
MN
Other
Enumeration date
07/17/2011
Last updated
07/17/2011
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