| NPI | 1801105473 |
|---|---|
| Former Name | AUDREY CELESTE RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2342133) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024172467) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5004901) | |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2020-09-10 |