Individual
MS. DALLAS GALE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
14277 ROAD 28, MADERA, CA 93638-5715
(559) 673-3508
(559) 661-2818
Mailing address
14277 ROAD 28, P.O. BOX 1288, MADERA, CA 93638-5715
(559) 673-3508
(559) 661-2818
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
461890
CA
Other
Enumeration date
05/09/2007
Last updated
07/08/2007
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