Amy Gauck Russo, FNP
Nurse Practitioner, Family in Grand Rapids, MI. Individual provider (NPI-1).
NPI number1316619901
StatusActive
Last updated in NPPESJul 24, 2025
Details
- NPI
- 1316619901
- Entity type
- Individual (NPI-1)
- Name
- Amy Gauck Russo
- Credential
- FNP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 1, 2021
- Certification date
- Jul 24, 2025
- Last updated
- Jul 24, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 4704302008 | MI | Yes |
| 363LF0000X | Nurse Practitioner, Family | 1052618 | TX |
Practice location
655 Kenmoor Ave Se Ste 200Grand Rapids, MI 49546-8622
Phone 616-363-7690 · Fax 616-942-8917
Mailing address
655 Kenmoor Ave Se Ste 200Grand Rapids, MI 49546-8622
Phone 616-363-7690 · Fax 616-942-8917
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