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General NPI Number Information
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NPI Number | 1376663849
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Entity Type | Individual
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Provider Name | DAWN MARIE RUSSO NP
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Gender | Female
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 3301 OVERSEAS HWY
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City | MARATHON
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State | FL
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Zip | 33050-2398
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Country | US
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Telephone | 516-368-4989
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Fax |
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Provider Business Mailing Address
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Address Line | 112 PARKER DR
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City | ISLAMORADA
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State | FL
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Zip | 33036-3835
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Country | US
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Telephone | 516-368-4989
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F332165
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11014872
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 413287
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License Number State | NY
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