Individual
SABRINA RUSSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-BC
Contact information
Practice address
6507 TOWN CENTER DR, CLARKSTON, MI 48346-4826
(248) 620-4000
Mailing address
6507 TOWN CENTER DR, CLARKSTON, MI 48346-4826
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704295757
MI
Other
Enumeration date
12/06/2021
Last updated
12/06/2021
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