Individual
KASEY LYNN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
221 NE GLEN OAK AVE, PEORIA, IL 61636-0001
(309) 672-4103
Mailing address
114 N OLIVE ST, WILLIAMSFIELD, IL 61489-5005
(309) 453-2338
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041413115
IL
Other
Enumeration date
08/02/2018
Last updated
08/02/2018
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