Individual
STEPHANIE M RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10639 MEETING STREET, SUITE 101, LOUISVILLE, KY 40059-7544
(502) 425-7827
(502) 412-3979
Mailing address
10639 MEETING STREET, SUITE 101, LOUISVILLE, KY 40059-7544
(502) 425-7827
(502) 412-3979
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
33992
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64012016
—
KY
Enumeration date
01/18/2006
Last updated
04/02/2008
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