| NPI | 1093152720 |
|---|---|
| Professional Name | NICOLE ELIZABETH RUSSO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: LA 6386) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: LA 6386) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2025-08-27 |