Individual
SAMANTHA LEIGH RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1459 MASSACHUSETTS AVE, LUNENBURG, MA 01462-1845
(860) 888-2379
Mailing address
1459 MASSACHUSETTS AVE, LUNENBURG, MA 01462-1845
(860) 888-2379
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86082667
MA
Other
Enumeration date
09/01/2020
Last updated
09/01/2020
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