Individual
DIANE RUSSO
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
4201 TUDOR CENTRE DR, SUITE 320, ANCHORAGE, AK 99508-5904
(907) 729-4955
Mailing address
1800 E PARKS HWY, WASILLA, AK 99654-7353
(907) 729-6000
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
100
AK
Other
Enumeration date
06/06/2006
Last updated
07/08/2007
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