Provider Demographics
NPI:1881920825
Name:RUSSIN, ANNE MARIE (NP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:RUSSIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:SEVENTH AVENUE @ 27TH STREET
Mailing Address - Street 2:ROOM A402
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5992
Mailing Address - Country:US
Mailing Address - Phone:212-217-4190
Mailing Address - Fax:212-217-4191
Practice Address - Street 1:227 WEST 27TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5992
Practice Address - Country:US
Practice Address - Phone:212-217-4190
Practice Address - Fax:212-217-4191
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF360390-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health