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Individual
MARY MARGARET RUSSELL
Active
Individual
MARY MARGARET RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
31549
MT
363LG0600X
Gerontology Nurse Practitioner
Primary
AP30004243
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801992466
—
WA
01
—
P01501773
RR MEDICARE
WA
Enumeration date
09/14/2006
Last updated
09/28/2015
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