| NPI | 1447690714 |
|---|---|
| Former Name | REBECCA A RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 016636) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 016636) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2022-05-25 |