Individual
MRS. DAWN MARIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4881 SUGAR MAPLE DR, 88TH MEDICAL GROUP, WRIGHT PATTERSON AFB, OH 45433-5250
(937) 257-1941
Mailing address
7392 FOXDALE DR, WAYNESVILLE, OH 45068-8200
(513) 855-4163
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1076380
MD
363A00000X
Physician Assistant
Primary
50.003959
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0110474
—
OH
Enumeration date
02/06/2007
Last updated
03/18/2020
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