Basic Information
| Provider Information | |||||||||
| NPI: | 1952508046 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | RUSSO | ||||||||
| FirstName: | NOREEN | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 PAGE RD | ||||||||
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| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283748749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102955511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4204 MURDOCKSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | WEST END | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273768871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102550055 | ||||||||
| FaxNumber: | 9102550060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.