Provider Demographics
NPI:1811889157
Name:RUSSO, NICHOLAS STEVEN
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:STEVEN
Last Name:RUSSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 STONEHEATH DR
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1058
Mailing Address - Country:US
Mailing Address - Phone:304-989-3938
Mailing Address - Fax:
Practice Address - Street 1:520 STONEHEATH DR
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1058
Practice Address - Country:US
Practice Address - Phone:304-989-3938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program