Individual
ANNA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1540 MAPLE RD, WILLIAMSVILLE, NY 14221-3647
(716) 568-3600
Mailing address
6968 LAKESIDE DR, NIAGARA FALLS, NY 14304-4671
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
028154
NY
Other
Enumeration date
03/14/2022
Last updated
03/15/2022
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