Individual
JENNA RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 MALLORY LN APT 27M, STARKVILLE, MS 39759-7109
(407) 462-8434
Mailing address
500 MALLORY LN APT 27M, STARKVILLE, MS 39759-7109
(407) 462-8434
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/25/2024
Last updated
03/25/2024
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