Provider Demographics
NPI:1366659153
Name:RUSSELL, ANN MARIE (IBCLC, RLC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12621 HEDGETREE CT
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-6432
Mailing Address - Country:US
Mailing Address - Phone:858-513-1327
Mailing Address - Fax:858-513-1327
Practice Address - Street 1:12621 HEDGETREE CT
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-6432
Practice Address - Country:US
Practice Address - Phone:858-513-1327
Practice Address - Fax:858-513-1327
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN