Latrece Russell

NPI #1073936100 in Chicago, Illinois

Provider Information

NPI Number: 1073936100
Entity Type: Individual
Name: Latrece Russell
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Technician, Other
Enumeration Date: Jan 24, 2014
Last Updated: Jan 24, 2014

Practice Location

Address: 4734 S PRAIRIE AVE
City: Chicago
State: Illinois
ZIP Code: 60615-1206
Phone: (708) 252-1958

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician, Other	247200000X	Primary

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