Jean Russo, LPN
Individual provider Active NPI Licensed Practical Nurse · Lisbon, NY
NPI 1720100233 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720100233
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 278222-1 (NY)
- Practice address
- 71 Keyes Rd
Lisbon, NY 13658-3204 - Phone
- (315) 393-7732
- NPI assigned
- Apr 4, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 278222-1 | NY | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 278222-1 | NY | Yes |
Addresses
Primary practice location
71 Keyes Rd
Lisbon, NY 13658-3204
Mailing address
71 Keyes Rd
Lisbon, NY 13658-3204
Phone (315) 393-7732
Other providers in Lisbon, NY
- Lisbon Central School
- Lisbon Medical Group
- Lisbon Medical Group
- Barbara Ann McBath
- Salvatore Micheal Puleo
- Kimberly Anne Sargent
- Terri Simzer
- United Helpers Care Inc
All providers in Lisbon, NY · Licensed Practical Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.