Healthcare Provider Details

I. General information

NPI: 1457219529
Provider Name (Legal Business Name): LORI RUSSELL QSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2026
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 5TH ST SE
DEVILS LAKE ND
58301-3618
US

IV. Provider business mailing address

410 5TH ST SE
DEVILS LAKE ND
58301-3618
US

V. Phone/Fax

Practice location:
  • Phone: 701-328-9858
  • Fax:
Mailing address:
  • Phone: 701-328-9858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: