Individual
JENNIFER RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
406 SAINT JULIEN AVE, LAFAYETTE, LA 70506-4622
(337) 366-6050
(337) 366-6051
Mailing address
1045 JOE MOUTON RD, SAINT MARTINVILLE, LA 70582-6225
(337) 278-3151
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
231237
LA
Other
Enumeration date
06/28/2023
Last updated
06/28/2023
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