Individual
BONNIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
419 INDIAN MEADOW DRIVE, GEORGETOWN, TX 78626
(512) 618-0348
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-8800
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT07456
TX
133V00000X
Registered Dietitian
—
—
Other
Enumeration date
09/17/2007
Last updated
01/07/2016
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