Individual
ELIZABETH RUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
64 MAPLE ST EXT, UNIT A, KENT, CT 06757
(860) 419-5925
Mailing address
64 MAPLE ST EXT, UNIT A, KENT, CT 06757
(860) 419-5925
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
12374
CT
Other
Enumeration date
09/18/2023
Last updated
09/18/2023
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