Individual
JESSICA DANIELLE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 W 27TH ST, LUMBERTON, NC 28358-3075
(910) 671-5000
Mailing address
635 MARSHTREE LN UNIT 301, FAYETTEVILLE, NC 28314-5550
(919) 818-4876
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
L005874
NC
Other
Enumeration date
04/16/2021
Last updated
04/16/2021
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