Individual
STEFANIE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LDN
Contact information
Practice address
12705 MOJAVE DR, FISHERS, IN 46037-4327
(732) 861-3703
Mailing address
12705 MOJAVE DR, FISHERS, IN 46037-4327
(732) 861-3703
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37003646A
IN
Other
Enumeration date
03/06/2024
Last updated
03/06/2024
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