| NPI | 1275854614 |
|---|---|
| Former Name | NICOLE MARIE RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME114420) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OH 35.129344) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2021-03-01 |