Provider Demographics
NPI:1437484540
Name:RUSSO, LIDIA (MSN CNP)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:MSN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26376 JOHN RD
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-1277
Mailing Address - Country:US
Mailing Address - Phone:440-235-7101
Mailing Address - Fax:
Practice Address - Street 1:26376 JOHN RD
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-1277
Practice Address - Country:US
Practice Address - Phone:440-235-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 11047 NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner