Most Relevant Information
Provider Data
| NPI Number: | 1003059106 |
| Provider Name: | ELLEN SUSAN RUSSO APRN,BC |
| Entity Type: | Individual |
| Taxonomy Code: | 364SP0809X |
| Specialty: | Clinical Nurse Specialist |
| License Number: | R046307 |
Most Important Dates
| Enumeration Date: | 04/20/2009 |
| Last Updated: | 04/20/2009 |
Provider Practice Location
CIRCLE DRIVE
BUILDING 5H
PERRY POINT
MD
21902
Practice Location Phone/Fax
| Phone: | 4106422411 |
| Fax: |
Provider Mailing Location
CIRCLE DRIVE
BUILDING 5H
PERRY POINT
MD
21902
Provider Mailing Phone/Fax
| Phone: | 4106422411 |
| Fax: |