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General NPI Number Information
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NPI Number | 1972904506
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Entity Type | Individual
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Provider Name | THERESA MARIE RUSSO NP
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Gender | Female
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | MASHAH WELLNESS STUDIOS, 181 RT 137, UNIT 3 TERRY RUSSO NP, WHOLISTIC HEALTH CARE
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City | HARWICH
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State | MA
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Zip | 02659
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Country | US
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Telephone | 401-236-7378
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Fax | 508-790-0808
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Provider Business Mailing Address
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Address Line | MASHAH WELLNESS STUDIOS, 181 RT 137, UNIT 3 TERRY RUSSO NP, WHOLISTIC HEALTH CARE
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City | HARWICH
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State | MA
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Zip | 02659
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Country | US
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Telephone | 401-236-7378
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Fax | 508-790-0808
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 227170
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License Number State | MA
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