Individual
TERI ALLEGRA RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
45 PINE ST, LANGLEY AFB, VA 23665-2025
(757) 764-6994
Mailing address
807 CAPTAIN JOHN SMITH RD, NEWPORT NEWS, VA 23606-3640
Taxonomy
Speciality
Code
Description
License number
State
163WW0101X
Ambulatory Women's Health Care Registered Nurse
Primary
0024080289
VA
Other
Enumeration date
08/18/2005
Last updated
07/08/2007
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