Individual
MR. MARK WILLIAM RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.A.
Contact information
Practice address
108 SCHOONER LANDING DR, EDENTON, NC 27932-8833
(252) 632-4137
Mailing address
108 SCHOONER LANDING DR, EDENTON, NC 27932-8833
(252) 632-4137
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
3666
NC
Other
Enumeration date
07/21/2008
Last updated
07/21/2008
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