Individual
ANNE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
500 W FORT ST BLDG 114, BOISE, ID 83702-4501
(208) 422-1000
Mailing address
743 W DEWEY AVE, NAMPA, ID 83686-2667
(208) 283-8025
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
63774
ID
Other
Enumeration date
05/07/2024
Last updated
05/07/2024
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