Individual
MRS. LAURA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
23 N GORE AVE STE 210, WEBSTER GROVES, MO 63119-2300
(314) 961-7605
Mailing address
23 N GORE AVE STE 210, WEBSTER GROVES, MO 63119-2300
(314) 961-7605
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2014042798
MO
Other
Enumeration date
12/21/2016
Last updated
09/21/2021
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