Individual
CASSANDRA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
207 W CHESTNUT ST, ROME, NY 13440-2739
(315) 832-1107
Mailing address
207 W CHESTNUT ST, ROME, NY 13440-2739
(315) 832-1107
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
312038
NY
Other
Enumeration date
06/26/2015
Last updated
06/26/2015
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