Individual
RUSSELL PAUL NYCUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
620 HOWARD AVE, ALTOONA, PA 16601-4804
(814) 889-4189
Mailing address
267 PARK HEIGHTS RD, BEDFORD, PA 15522-3875
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP025550
PA
Other
Enumeration date
04/29/2022
Last updated
04/29/2022
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