Individual
RENE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
2416 SW WINTERGREEN CT, LEES SUMMIT, MO 64081
(816) 550-7176
Mailing address
950 CAMPBELL AVE, WEST HAVEN, CT 06516-2770
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
7778
CT
Other
Enumeration date
09/18/2018
Last updated
09/18/2018
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