Individual
MRS. CAROLYN RENEE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
502 BRYAN DR, ENID, OK 73701-6908
(940) 256-3771
Mailing address
502 BRYAN DR, ENID, OK 73701-6908
(940) 256-3771
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Enumeration date
04/18/2017
Last updated
04/18/2017
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