NPI 1073936100

Latrece Russell

Practitioner Other Technician Chicago, IL

Practice location

Address: 4734 S Prairie Ave, Chicago, IL 60615-1206
Phone: (708) 252-1958
Mailing address: 4734 S Prairie Ave Unit1, Chicago, IL 60615-1206

Registered specialties

Other Technician Primary

Technologists, Technicians & Other Technical Service Providers Taxonomy 247200000X

Other Technician, Other providers in Illinois →

Registry record

NPI: 1073936100
Entity type: Individual
Sex (as registered): Female
NPI issued: 24 Jan 2014
Record last updated: 24 Jan 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.