Individual
LORI YOUNGER RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CERT. HAIR LOSS SPEC
Contact information
Practice address
6133 BACKLICK RD, SPRINGFIELD, VA 22150-2637
(571) 230-6302
Mailing address
1803 HYDEN PL, WOODBRIDGE, VA 22191-4435
(571) 230-6302
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
1204018222
VA
Other
Enumeration date
12/06/2016
Last updated
06/05/2023
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