Individual
KATHRYN D RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
147 MILK ST, PROVIDER ENROLLMENT DEPT. - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8374
(617) 421-3487
Mailing address
133 BROOKLINE AVE, BOSTON, MA 02215-3904
(617) 421-1194
(617) 421-1187
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
239289
MA
Other
Enumeration date
03/13/2008
Last updated
03/13/2008
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