Theresa A Russell, FNP
Nurse Practitioner, Family in Enterprise, OR. Individual provider (NPI-1).
NPI number1629061981
StatusActive
Last updated in NPPESDec 13, 2013
Details
- NPI
- 1629061981
- Entity type
- Individual (NPI-1)
- Name
- Theresa A Russell
- Credential
- FNP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 23, 2005
- Last updated
- Dec 13, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 91000286 | OR | Yes |
Practice location
406 Ne 1st StEnterprise, OR 97828-1168
Phone 541-426-4502 · Fax 541-426-6403
Mailing address
406 Ne 1st StEnterprise, OR 97828-1168
Phone 541-426-4502 · Fax 541-426-6403
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