Individual
ANNALISE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1514 JEFFERSON HWY, JEFFERSON, LA 70121-2429
(866) 624-7637
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
328185
LA
Other
Enumeration date
07/28/2021
Last updated
10/20/2021
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