Individual
INAE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
735 FITZWATERTOWN RD STE 1, WILLOW GROVE, PA 19090-1338
(215) 657-2012
Mailing address
735 FITZWATERTOWN RD STE 1, WILLOW GROVE, PA 19090-1338
(215) 657-2012
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
SP030858
PA
Other
Enumeration date
10/15/2024
Last updated
10/15/2024
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