Individual
RUSSELL SAMUEL HOUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
5501 OLD YORK RD, PHILADELPHIA, PA 19141-3018
(215) 456-7890
Mailing address
5501 OLD YORK RD, PHILADELPHIA, PA 19141-3018
(215) 456-7190
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
SP024930
PA
363LC0200X
Critical Care Medicine Nurse Practitioner
SP024930
PA
Other
Enumeration date
02/25/2022
Last updated
07/25/2022
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