Individual
RACHELLE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1915 RHODES ST, MADISON, IL 62060-1355
(618) 402-6818
Mailing address
PO BOX 25, MADISON, IL 62060-0025
(618) 402-6818
Taxonomy
Speciality
Code
Description
License number
State
246RM2200X
Medical Laboratory Technician
—
—
246RP1900X
Phlebotomy Technician
Primary
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
11/05/2015
Last updated
09/04/2021
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