Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 055.0031551 | VT |
Y | 207QA0505X | Family Doctor - Adult Medicine | 055.0031551 | VT |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 055.0031551 | VT |
NPI | 1699361022 |
---|---|
Provider Name | Danielle Aline Russin |
First Address | Swanton, VT 05488-8094 |
Second Address | Swanton, VT 05488-1335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2020 |
Last Update Date | 07/02/2022 |