Individual
LAURIE TILLERY-RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1500 MARKET ST, PHILADELPHIA, PA 19102-2100
(267) 324-5707
Mailing address
1500 MARKET ST, PHILADELPHIA, PA 19102-2100
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SPO12098
PA
Other
Enumeration date
04/23/2013
Last updated
04/19/2016
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