Individual
AMY GAUCK RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
655 KENMOOR AVE SE STE 200, GRAND RAPIDS, MI 49546-8622
(616) 363-7690
(616) 942-8917
Mailing address
655 KENMOOR AVE SE STE 200, GRAND RAPIDS, MI 49546-8622
(616) 363-7690
(616) 942-8917
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
1052618
TX
363LF0000X
Family Nurse Practitioner
Primary
4704302008
MI
Other
Enumeration date
10/01/2021
Last updated
07/24/2025
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