Individual provider · Type 1 NPI
Corretta N. Henry-Russell
Clinic/Center · Sanford, FL
NPI number
1063067098
Active
Practice location
1672 Stargazer Ter
Sanford, FL 32771-9286
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Developmental Disabilities Clinic/Center | 261QD1600X | None listed |
| Clinic/Center Primary | 261Q00000X | None listed |
Clinic/Center: A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
About NPI 1063067098
Corretta N. Henry-Russell's National Provider Identifier is 1063067098, issued on Aug 6, 2019. The primary taxonomy on file is Clinic/Center (261Q00000X), and the practice location is in Sanford, FL. The record was last updated on Aug 6, 2019.