# WINOOSKI INTEGRATIVE MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619694478
- **Authorized official:** SAM RUSSO ND,LAC, RMSK (PRINCIPAL)
- **Authorized official phone:** (802) 636-4133

## Contact information

- **Practice address:** 321 MAIN ST STE B, WINOOSKI, VT 05404-1380
- **Practice address phone:** (802) 636-4133
- **Mailing address:** 321 MAIN ST STE B, WINOOSKI, VT 05404-1380
- **Mailing address phone:** (802) 636-4133

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171100000X | Acupuncturist | — | NULL | — |
| 171100000X | Acupuncturist | — | — | — |
| 175F00000X | Naturopath | — | NULL | — |
| 175F00000X | Naturopath | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 10/24/2022
- **Last updated:** 02/14/2025