Individual
SUSAN LEE RUSSO
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
C.N.M.
Contact information
Practice address
4001 FAIR RIDGE DR, SUITE 303, FAIRFAX, VA 22033-2917
(703) 359-4842
Mailing address
3701 FIERY RUN RD, LINDEN, VA 22642-1831
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
0024094866
VA
Other
Enumeration date
10/31/2005
Last updated
07/08/2007
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