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NPI Code Detail

MEDICARE: MARIA L RUSSO RN

MEDICARE: MARIA L RUSSO RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN081292LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19701OTHERNCANCB

General Provider Information

NPI Number : 1063445518
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA L RUSSO RN
Provider Business Mailing Address
First Line : 512 RODERICK ST
Second Line : SUITE 200
City : MORGAN CITY
State : LA
Zip : 70380-2247
Country : US
Telephone Number : 985-380-2455
Fax Number : 985-380-2470
Provider Business Practice Location Address
First Line : 512 RODERICK ST
Second Line : SUITE 200
City : MORGAN CITY
State : LA
Zip : 70380-2247
Country : US
Telephone Number : 985-380-2455
Fax Number : 985-380-2470
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2006
Last Update Date : 07/08/2007

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