Individual
MARY A RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 MEDICAL CENTER DRIVE, MORGANTOWN, WV 26506
(304) 598-4032
Mailing address
PO BOX 8031, MORGANTOWN, WV 26506-8031
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
20120468
WV
Other
Enumeration date
05/18/2011
Last updated
05/18/2011
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