Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | APN.0100009-CNS | CO |
N | 363LC1500X | Nurse Practitioner - Community Health | APN.0100009-CNS | CO |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 309003290 | IL |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APN.0100009-CNS | CO |
NPI | 1255477196 |
---|---|
Provider Name | Mrs. Susan T Russo |
First Address | Durango, CO 81303-8276 |
Second Address | Durango, CO 81301-5056 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 12/01/2018 |