Individual
MARY JO RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2300 53RD AVE, SUITE 100, BETTENDORF, IA 52722-7564
(563) 322-0971
(563) 324-0615
Mailing address
2300 53RD AVE, SUITE 100, BETTENDORF, IA 52722-7564
(563) 322-0971
(563) 324-0615
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001347
IA
Other
Enumeration date
01/09/2006
Last updated
11/08/2013
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