Individual
LATONYA MICHELLE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1623 CAROLINA ST, GARY, IN 46407-2346
(219) 771-0689
Mailing address
1623 CAROLINA ST, GARY, IN 46407-2346
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
Primary
28273063A
IN
Other
Enumeration date
01/03/2024
Last updated
01/03/2024
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