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Individual

MRS. MAGNOLIA UMALI RUSSELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RDN,LD

Contact information

Practice address
597 LYTHAM DR, AIKEN, SC 29801-1183
(814) 248-6768
Mailing address
597 LYTHAM DR, AIKEN, SC 29801-1183
(814) 248-6768

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2353
SC
133V00000X
Registered Dietitian
LD005992
GA

Other

Enumeration date
11/18/2022
Last updated
11/18/2022
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