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Individual
MRS. TRINA MARY RUSSO
Active
Individual
MRS. TRINA MARY RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
TR001571
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2760454
—
MI
01
—
480E020980
BS MICH
MI
01
—
5505057
BS MI
—
Enumeration date
12/23/2005
Last updated
12/29/2016
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