Individual
JESSICA RUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCP
Contact information
Practice address
10930 N TATUM BLVD, STE 103, PHOENIX, AZ 85028-6069
(602) 263-7600
(602) 212-0365
Mailing address
10930 N TATUM BLVD, STE 103, PHOENIX, AZ 85028-6069
(602) 263-7600
(602) 212-0365
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
LP030
NV
Other
Enumeration date
11/18/2014
Last updated
11/18/2014
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