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General NPI Number Information
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NPI Number | 1841358603
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Entity Type | Individual
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Provider Name | HEATHER LYNN RUSSO PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 224 W LORAIN ST STE 100
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City | OBERLIN
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State | OH
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Zip | 44074-1087
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Country | US
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Telephone | 440-775-1881
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Fax | 440-744-5707
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Provider Business Mailing Address
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Address Line | 3520 LONGWOOD DR
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City | MEDINA
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State | OH
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Zip | 44256-8400
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Country | US
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Telephone | 330-239-0780
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50001980
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License Number State | OH
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