Individual
MRS. CAROLYN VETTA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, RN, CFNP
Contact information
Practice address
840 N OAK AVE, RULEVILLE, MS 38771-3227
(662) 756-2711
(662) 756-4114
Mailing address
121 GIRL SCOUT RD, GRENADA, MS 38901-9283
(662) 226-7311
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
143980
MS
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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