Individual
KRISTIN RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP-BC
Contact information
Practice address
105 MEDICAL CENTER DR, SUITE 303, SLIDELL, LA 70461-5544
(985) 661-3591
Mailing address
105 MEDICAL CENTER DR, SUITE 303, SLIDELL, LA 70461-5544
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
AP08757
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09801776
—
MS
05
—
2428357
—
LA
Enumeration date
05/27/2016
Last updated
10/31/2016
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