Individual
DOROTHEA D RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MS, CNP
Contact information
Practice address
2828 CHICAGO AVE SOUTH, SUITE 200, MINNEAPOLIS, MN 55407-1320
(612) 879-1000
(612) 879-9116
Mailing address
2828 CHICAGO AVE SOUTH, SUITE 200, MINNEAPOLIS, MN 55407-1320
(612) 879-1000
(612) 879-9116
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
R0611606
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
303664200
—
MN
Enumeration date
06/08/2005
Last updated
10/21/2008
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