Individual
TIERRA RENE RUSSAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
29079 ANNAPOLIS RD STE 510, WESTLAND, MI 48186-5104
(313) 919-0655
Mailing address
500 MADISON AVE STE 510, TOLEDO, OH 43604-1210
(419) 215-7886
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
DWP3647
MI
Other
Enumeration date
08/18/2020
Last updated
08/18/2020
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