Individual
CAELI A RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
759 CHESTNUT ST, SPRINGFIELD, MA 01199
(413) 794-0000
Mailing address
280 CHESTNUT STREET, 2ND FL, SPRINGFIELD, MA 01199-1001
(413) 794-5700
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA6190
MA
Other
Enumeration date
07/21/2017
Last updated
07/20/2018
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