Individual
KARREN RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2495 SHREVEPORT HWY, PINEVILLE, LA 71360-4044
(318) 473-0010
Mailing address
2495 SHREVEPORT HWY, PINEVILLE, LA 71360-4044
(318) 473-0010
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
L12631R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1541362
—
LA
01
—
P00178010
TRAVELERS MEDICARE
—
Enumeration date
03/28/2006
Last updated
09/11/2023
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