Individual
JESSICA C RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
111 COLCHESTER AVE, BURLINGTON, VT 05401-1473
(802) 578-8566
Mailing address
111 COLCHESTER AVE, BURLINGTON, VT 05401-1473
(802) 578-8566
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
014111
NY
363A00000X
Physician Assistant
055.0031118
VT
Other
Enumeration date
07/26/2010
Last updated
01/25/2012
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