Individual
RENEE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
501 MARKET ST, LEWISBURG, PA 17837-3002
(570) 524-0900
Mailing address
254 MARKET ST, MIFFLINBURG, PA 17844-1333
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
9906930
PA
Other
Enumeration date
07/13/2007
Last updated
07/13/2007
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