Individual
LILY MARIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
15 ENTERPRISE DR, AUGUSTA, ME 04330-7997
(207) 621-8880
Mailing address
1109 TURNER ST, AUBURN, ME 04210-6426
(207) 513-2896
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2691
ME
Other
Enumeration date
09/19/2023
Last updated
08/28/2024
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