Provider Demographics
NPI:1124699491
Name:RUSSO, BARBARA ANN (LPN)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:RUSSO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MEADOWVALE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-2847
Mailing Address - Country:US
Mailing Address - Phone:781-883-1344
Mailing Address - Fax:
Practice Address - Street 1:19 MEADOWVALE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-2847
Practice Address - Country:US
Practice Address - Phone:781-883-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN58661164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse