Individual
MELINDA ROCHELLE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
23999 NORTHWESTERN HWY STE 114, SOUTHFIELD, MI 48075-2578
(248) 278-8937
Mailing address
18701 BRETTON DR, DETROIT, MI 48223-1379
(313) 703-9710
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704266784
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704266784
NURSE PRACTITIONER
MI
Enumeration date
04/25/2018
Last updated
04/25/2018
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