Individual
KAREN M RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
433 W DONALD ST, APARTMENT 101, WATERLOO, IA 50703-1245
(318) 359-2793
Mailing address
433 W DONALD ST, APARTMENT 101, WATERLOO, IA 50703-1245
(318) 359-2793
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
X000105546
IOWA MEDICAID ENTERPRISE
IA
Enumeration date
01/09/2013
Last updated
01/09/2013
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