Individual
BRIANA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4201 DEAN LAKES BLVD STE 120, SHAKOPEE, MN 55379-2850
(952) 496-6700
Mailing address
13167 22ND ST N, STILLWATER, MN 55082-2529
(651) 528-2885
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14809
MN
Other
Enumeration date
03/04/2024
Last updated
03/04/2024
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