Provider Demographics
NPI:1689374134
Name:RUSSO-ALESI, ERICA DOSTIE (FNP-C)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:DOSTIE
Last Name:RUSSO-ALESI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:5470 MARTHA BERRY HWY NE
Practice Address - Street 2:
Practice Address - City:ARMUCHEE
Practice Address - State:GA
Practice Address - Zip Code:30105-2302
Practice Address - Country:US
Practice Address - Phone:762-235-3830
Practice Address - Fax:706-291-9391
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN258303363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner