Individual
KIMBERLY ANN RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, RD, LDN
Contact information
Practice address
180 JOAN DR, TRAPPE, PA 19426-1957
(610) 304-7174
Mailing address
180 JOAN DR, TRAPPE, PA 19426-1957
(610) 304-7174
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN001138
PA
Other
Enumeration date
01/31/2024
Last updated
01/31/2024
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