Provider Demographics
NPI:1245118280
Name:RUSSELL, LOUISE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MA
Mailing Address - Zip Code:01541-1108
Mailing Address - Country:US
Mailing Address - Phone:978-464-2141
Mailing Address - Fax:978-464-2141
Practice Address - Street 1:162 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MA
Practice Address - Zip Code:01541-1108
Practice Address - Country:US
Practice Address - Phone:978-464-2141
Practice Address - Fax:978-464-2141
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2346226163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)