Individual
NICOLE ELIZABETH RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
810 NORTH 6TH AVE., SANDPOINT, ID 83864
(208) 265-6252
Mailing address
810 NORTH 6TH AVE., SANDPOINT, ID 83864
(208) 265-6252
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-16119
ID
207Q00000X
Family Medicine Physician
MED-PHYS-LIC-58693
MT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/06/2014
Last updated
03/20/2024
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