| Doctor Name: | MRS. ELLEN SUSAN RUSSO |
| NPI Number: | 1003059106 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN,BC |
| License Number: | R046307 |
| Business Practice Address: | Circle Drive Building 5h Perry Point, MD - 21902 |
| Business Phone Number: | 4106422411 |
| Business Fax Number: | |
| Mailing Address: | Circle Drive, Building 5h PERRY POINT |
| State: | MD |
| Postal Code: | 21902 |
| Phone Number: | 4106422411 |
| Fax Number: | |
| NPI Enumeration Date: | 04/20/2009 |
| NPI Last Update Date: | 04/20/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SP0809X |
| License Number: | R046307 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |