Individual
NATASHA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1545 ATLANTIC AVE, BROOKLYN, NY 11213-1122
(718) 613-4021
Mailing address
1545 ATLANTIC AVE, BROOKLYN, NY 11213-1122
(718) 613-4021
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
00000000000
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NRUSSELL1
N/A
—
Enumeration date
05/04/2018
Last updated
05/04/2018
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