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Individual

ANTOINETTE RUSSELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2922 W WHITE MOUNTAIN BLVD, LAKESIDE, AZ 85929-6152
(928) 368-6112
(928) 368-5643
Mailing address
2922 W WHITE MOUNTAIN BLVD, LAKESIDE, AZ 85929-6152
(928) 368-6112
(928) 368-5643

Taxonomy

Speciality
Code
Description
License number
State
146L00000X
Paramedic
Primary
111
AZ
146N00000X
Basic Emergency Medical Technician
111
AZ

Other

Enumeration date
02/20/2015
Last updated
02/20/2015
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