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Individual

MADISON RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 239-1801
Mailing address
231 RAVINE DR, POCATELLO, ID 83204-4026
(360) 670-9047

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F04260453
ID

Other

Enumeration date
05/01/2026
Last updated
05/01/2026
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