Individual
DANIEL JAMES RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
677 E STATE ST, BURLINGTON, WI 53105-1639
(262) 763-9531
Mailing address
8610 45TH AVE, KENOSHA, WI 53142-2435
(262) 939-4744
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
13237-33
WI
Other
Enumeration date
02/12/2024
Last updated
02/12/2024
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