Individual
MRS. PATRICIA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CDN
Contact information
Practice address
288 SHERMAN AVE, HAWTHORNE, NY 10532-1912
(914) 747-1397
Mailing address
288 SHERMAN AVE, HAWTHORNE, NY 10532-1912
(914) 747-1397
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
002403
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002403
NY STATE DIETETIC LICENSE
NY
01
—
596830
ADA DIETETIC REGISTRATION
NY
Enumeration date
05/09/2007
Last updated
07/08/2007
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