Basic Information
| Provider Information | |||||||||
| NPI: | 1801906797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BISESI | ||||||||
| FirstName: | RUSSELL | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | APRN BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136 WELD ST | ||||||||
| Address2: | |||||||||
| City: | ROSLINDALE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021311042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177559898 | ||||||||
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| Practice Location | |||||||||
| Address1: | 420 MAIN ST | ||||||||
| Address2: | BOSTON HEALTH CARE | ||||||||
| City: | WALPOLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020813753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086607949 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 03/21/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0807X | 242633 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Child & Adolescent | 364SP0808X | 242633 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
No ID Information.