Individual
NICHOLE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
175 N GROESBECK HWY, MOUNT CLEMENS, MI 48043-1562
(586) 713-5112
Mailing address
175 N GROESBECK HWY, MOUNT CLEMENS, MI 48043-1562
(586) 713-5112
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/04/2020
Last updated
03/21/2023
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