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General NPI Number Information
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NPI Number | 1891217022
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Entity Type | Individual
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Provider Name | LISA C RUSSO APRN
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Gender | Female
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Dates
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Enumeration Date | 07/10/2017
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 1 CELLINI PL STE 102
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City | WEST HAVEN
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State | CT
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Zip | 06516-1666
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Country | US
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Telephone | 203-932-6481
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Fax |
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Provider Business Mailing Address
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Address Line | 38 RICHILL RD
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City | BRANFORD
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State | CT
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Zip | 06405-2604
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Country | US
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Telephone | 203-871-9975
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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 | 7045
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License Number State | CT
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