Individual
KAREN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1002 HOUSTON AVE, TAKOMA PARK, MD 20912-7317
(301) 796-8669
Mailing address
1002 HOUSTON AVE, TAKOMA PARK, MD 20912-7317
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
103360
NC
Other
Enumeration date
06/04/2012
Last updated
06/04/2012
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