Provider Demographics
NPI:1851960512
Name:TRUSSELL, MCKALEY
Entity Type:Individual
Prefix:
First Name:MCKALEY
Middle Name:
Last Name:TRUSSELL
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 1:1007 KOALA DR
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9247
Mailing Address - Country:US
Mailing Address - Phone:509-826-6191
Mailing Address - Fax:509-826-3029
Practice Address - Street 1:1007 KOALA DR
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9247
Practice Address - Country:US
Practice Address - Phone:509-826-6191
Practice Address - Fax:509-826-3029
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist