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NPI Code Detail

MEDICARE: TRACEY SARRO RUSSO NP

MEDICARE: TRACEY SARRO RUSSO NP
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
1363LF0000XFamily Nurse PractitionerRN281950MA

General Provider Information

NPI Number : 1558602391
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACEY SARRO RUSSO NP
Provider Business Mailing Address
First Line : 370 MERRIMACK ST
Second Line :
City : LAWRENCE
State : MA
Zip : 01843-1788
Country : US
Telephone Number : 978-557-8800
Fax Number : 978-557-8633
Provider Business Practice Location Address
First Line : 370 MERRIMACK ST
Second Line :
City : LAWRENCE
State : MA
Zip : 01843-1788
Country : US
Telephone Number : 978-557-8800
Fax Number : 978-557-8633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2013
Last Update Date : 12/13/2021

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Directions to “ TRACEY SARRO RUSSO NP” Practice Location

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