Individual
WANDA L RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
620 N MORRISON BLVD, SUITE G, HAMMOND, LA 70401-2312
(985) 543-4113
(985) 543-4109
Mailing address
620 N MORRISON BLVD, SUITE G, HAMMOND, LA 70401-2312
(985) 543-4113
(985) 543-4109
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
445
LA
Other
Enumeration date
06/08/2009
Last updated
01/31/2013
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