Individual
ANNETTE M RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1230 E 1ST ST, CASPER, WY 82601-2704
(307) 266-3174
(307) 261-6713
Mailing address
1230 E 1ST ST, CASPER, WY 82601-2704
(307) 266-3174
(307) 261-6713
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
205
WY
Other
Enumeration date
05/31/2006
Last updated
07/08/2007
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