Russo, Bryce Lauren

Russo, Bryce Lauren is an individual health care provider with primary practice located at 1 Childrens Pl Div Ped Hematology & Onc, Saint Louis MO 63110-1002. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Primary Care, Physician Assistants & Advanced Practice Nursing Providers / Acute Care. Physician Assistants & Advanced Practice Nursing Providers / Acute Care is her primary health care specialty. Russo, Bryce Lauren can be contacted via phone (314) 454-6018.

Contact Information

Primary practice address
1 Childrens Pl Div Ped Hematology & Onc Saint Louis MO 63110-1002
Phone: (314) 454-6018
Fax: (844) 621-4392
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X 2019005207 Missouri
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 2019005207 Missouri

Profile Details

NPI number 1932532462
LBN Legal business name Russo, Bryce Lauren
Credentials Pediatric Nurse Practitioner (PNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 20th, 2013
Last updated Nov 15th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932532462 NPPES
Missouri MEDICAID 420076824

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