Individual
NICOLE MARIE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, RN, CCRN, CPNP
Contact information
Practice address
HSC T11-020, STONY BROOK, NY 11794-0001
(516) 306-6989
Mailing address
101 NICOLLS RD, STONY BROOK, NY 11794-8111
(631) 620-4195
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
776987
NY
363LP0200X
Pediatric Nurse Practitioner
Primary
393742
NY
Other
Enumeration date
07/15/2025
Last updated
12/21/2025
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