Provider Demographics
NPI:1972904506
Name:RUSSO, THERESA MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:MARIE
Last Name:RUSSO
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Gender:
Credentials:NP
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Mailing Address - Street 1:MASHAH WELLNESS STUDIOS, 181 RT 137, UNIT 3
Mailing Address - Street 2:TERRY RUSSO NP, WHOLISTIC HEALTH CARE
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02659
Mailing Address - Country:US
Mailing Address - Phone:401-236-7378
Mailing Address - Fax:508-790-0808
Practice Address - Street 1:MASHAH WELLNESS STUDIOS, 181 RT 137, UNIT 3
Practice Address - Street 2:TERRY RUSSO NP, WHOLISTIC HEALTH CARE
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02659
Practice Address - Country:US
Practice Address - Phone:401-236-7378
Practice Address - Fax:508-790-0808
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2025-04-23
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Provider Licenses
StateLicense IDTaxonomies
MA227170363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner