Individual
GINA RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
175 BURNING TREE RD, PINEHURST, NC 28374-9594
(732) 513-1704
Mailing address
175 BURNING TREE RD, PINEHURST, NC 28374-9594
(732) 513-1704
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-15596
NC
Other
Enumeration date
08/11/2025
Last updated
08/11/2025
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