Individual
MATTHEW RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 W BROAD ST, SUITE 506, BETHLEHEM, PA 18018-5717
(610) 954-5810
Mailing address
156 TURKEY RD, KEMPTON, PA 19529-8734
(908) 304-5738
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN619623
PA
Other
Enumeration date
09/03/2015
Last updated
09/03/2015
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