Individual
MRS. MARY MONICA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LRD, CDE
Contact information
Practice address
1702 EAST ROSE CREEK PARKWAY SOUTH, FARGO, ND 58104-6834
(701) 239-4946
Mailing address
LANDSTUHL REGIONAL MEDICAL CENTER, CMR 402, APO, AE 09180
0114915221310207
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
151
ND
Other
Enumeration date
11/11/2009
Last updated
11/11/2009
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