Individual
DIANE R RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1160 E 3900 S STE 2000, SALT LAKE CITY, UT 84124-1236
(801) 266-3418
(801) 266-4174
Mailing address
PO BOX 741729, ATLANTA, GA 30374-1729
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5648785-4405
UT
363L00000X
Nurse Practitioner
Primary
5648785-4405
UT
Other
Enumeration date
10/27/2019
Last updated
02/09/2022
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