Individual
EVANGELINE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
3686 PACIFIC AVE, RIVERSIDE, CA 92509-1948
(951) 801-2913
Mailing address
3686 PACIFIC AVE, RIVERSIDE, CA 92509-1948
(951) 801-2913
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN221803
CA
Other
Enumeration date
06/30/2008
Last updated
06/30/2008
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