Individual
EVAN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
780 ALBANY ST, BOSTON, MA 02118-2524
(857) 654-1000
Mailing address
14 REMINGTON ST, APT 101, CAMBRIDGE, MA 02138-5208
(603) 819-9552
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2306774
MA
363L00000X
Nurse Practitioner
Primary
RN2306774
MA
Other
Enumeration date
09/06/2016
Last updated
08/11/2017
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