Individual
MARYANNE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
9900 BREN RD E, MINNETONKA, MN 55343-9664
(706) 896-3708
Mailing address
PO BOX 13, HIAWASSEE, GA 30546-0013
(706) 896-3708
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN154916
GA
Other
Enumeration date
07/14/2014
Last updated
09/20/2020
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