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General NPI Number Information
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NPI Number | 1336426634
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Entity Type | Individual
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Provider Name | RACHEL ANN RUSS P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 67 UNION ST
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City | NATICK
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State | MA
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Zip | 01760-7700
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Country | US
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Telephone | 508-532-6626
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Fax |
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Provider Business Mailing Address
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Address Line | 2 WOODVIEW WAY UNIT B32
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City | HOPKINTON
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State | MA
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Zip | 01748-2849
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Country | US
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Telephone | 440-666-3404
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA5737
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00263600
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License Number State | NJ
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