Healthcare Provider Details

I. General information

NPI: 1346583994
Provider Name (Legal Business Name): CHRISTINE ELLEN RUSSO BS RN-BC CARN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OLD DOVER RD
ROCHESTER NH
03867-3464
US

IV. Provider business mailing address

50 BLACKWATER RD
ROCHESTER NH
03867-4613
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-9300
  • Fax: 603-335-9278
Mailing address:
  • Phone: 603-335-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number011341-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: