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Individual

LISA NICOLE RUSSELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3001 BLADENSBURG RD NE # 101, WASHINGTON, DC 20018-2235
(202) 635-5767
Mailing address
6317 PENNSYLVANIA AVE APT 102, DISTRICT HEIGHTS, MD 20747-3003
(240) 470-6019

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Enumeration date
07/13/2023
Last updated
07/16/2023
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