Individual
MRS. NATALIE ELISE RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
301 J T STITES BLVD, SALLISAW, OK 74955-9302
(918) 774-1481
Mailing address
301 SOUTH J.T. STITES, SALLISAW, OK 74955
(918) 774-1481
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1883
OK
Other
Enumeration date
10/18/2005
Last updated
07/08/2007
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