Individual
MR. VINCE R RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
4305 GYPSY LN, COLLEGEVILLE, PA 19426-1165
(484) 902-8223
(267) 354-6899
Mailing address
4305 GYPSY LN, COLLEGEVILLE, PA 19426-1165
(484) 902-8223
(267) 354-6899
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN262002
PA
Other
Enumeration date
03/23/2007
Last updated
07/08/2007
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