Individual
RUSSELL JOSEPH RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1825 LOGAN AVE, WATERLOO, IA 50703-1916
(319) 235-3886
Mailing address
1825 LOGAN AVE, WATERLOO, IA 50703-1916
(319) 235-3886
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
098331
IA
Other
Enumeration date
06/12/2025
Last updated
06/12/2025
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