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General NPI Number Information
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NPI Number | 1245219815
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Entity Type | Individual
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Provider Name | THERESA LYNN RUSSO N.P.
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Gender | Female
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 101 PINE ST
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City | SYRACUSE
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State | NY
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Zip | 13210-1149
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Country | US
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Telephone | 315-422-8105
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Fax | 315-471-9903
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Provider Business Mailing Address
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Address Line | 101 PINE ST
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City | SYRACUSE
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State | NY
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Zip | 13210-1149
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Country | US
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Telephone | 315-422-8105
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Fax | 315-471-9903
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F330527-1
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License Number State | NY
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