Individual
BRIDGET RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
410 NW LAWRENCE ST, HOXIE, AR 72433-1124
(870) 759-0141
Mailing address
410 NW LAWRENCE ST, HOXIE, AR 72433-1124
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
73201
AR
390200000X
Student in an Organized Health Care Education/Training Program
Primary
73201
AR
Other
Enumeration date
01/06/2015
Last updated
01/06/2015
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