Individual
JEANNE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
725 ALBANY STREET, SUITE 3B, SHAPIRO BLDG., BOSTON, MA 02118-2308
(176) 414-4861
(617) 414-3617
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118-2371
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA5910
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3143566
—
NH
05
—
PA5910
—
MA
Enumeration date
10/18/2016
Last updated
10/30/2024
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