Individual
BRENDA SIMASIKU RUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2105 W 143RD ST # 2ND, BURNSVILLE, MN 55306-8000
(952) 303-6832
Mailing address
10200 HIDDEN OAKS LN N, CHAMPLIN, MN 55316-3043
(612) 432-6964
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
8307
MN
Other
Enumeration date
07/28/2021
Last updated
09/24/2021
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