Individual
KYLE RUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNS
Contact information
Practice address
640 GINGER TRL, LAKE ZURICH, IL 60047-2539
(847) 971-9429
Mailing address
640 GINGER TRL, LAKE ZURICH, IL 60047-2539
(847) 971-9429
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
171400000X
Health & Wellness Coach
—
—
Other
Enumeration date
02/21/2024
Last updated
02/21/2024
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