Individual
SUSAN RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
1301 BARBARA JORDAN BLVD, SUITE 200, AUSTIN, TX 78723-3077
(512) 628-1820
(512) 628-1821
Mailing address
1301 BARBARA JORDAN BLVD, SUITE 200, AUSTIN, TX 78723-3077
(512) 628-1820
(512) 628-1821
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
755964
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
333176101
—
TX
05
—
333176102
—
TX
Enumeration date
12/10/2013
Last updated
11/25/2014
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