Provider Demographics
NPI:1710567516
Name:RUSSELL, JULIA FRANCES
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:FRANCES
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BENTLEY ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2901
Mailing Address - Country:US
Mailing Address - Phone:508-971-0070
Mailing Address - Fax:
Practice Address - Street 1:17 BENTLEY ST APT 1
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2901
Practice Address - Country:US
Practice Address - Phone:508-971-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program