Individual
MRS. NICOLE THERESE RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(774) 270-4938
Mailing address
25 KELSEY RD, NATICK, MA 01760-3329
(774) 270-4938
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200540747RN
OR
163W00000X
Registered Nurse
N-39148
ID
163W00000X
Registered Nurse
Primary
RN2260824
MA
163W00000X
Registered Nurse
RN60083206
WA
163W00000X
Registered Nurse
RN9292245
FL
Other
Enumeration date
07/12/2011
Last updated
07/12/2011
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