Individual
ASHLEY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13929 HAWKS BEARD, SISTERS, OR 97759-0089
(541) 623-0711
Mailing address
13929 HAWKS BEARD, SISTERS, OR 97759-0089
(541) 623-0711
Taxonomy
Speciality
Code
Description
License number
State
374K00000X
Religious Nonmedical Practitioner
Primary
—
—
Other
Enumeration date
12/12/2022
Last updated
12/12/2022
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