Provider Demographics
NPI:1093924904
Name:RUSSO HOURI, DEBRA A (MS, CCN)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:A
Last Name:RUSSO HOURI
Suffix:
Gender:F
Credentials:MS, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S. WHITING STREET
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304
Mailing Address - Country:US
Mailing Address - Phone:703-485-6965
Mailing Address - Fax:571-431-7453
Practice Address - Street 1:101 S WHITING ST
Practice Address - Street 2:SUITE 208
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3418
Practice Address - Country:US
Practice Address - Phone:703-485-6965
Practice Address - Fax:571-431-7453
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist