Individual
MARIA JEANETTE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
20120 BALLINGER WAY NE, SHORELINE, WA 98155-1117
(206) 365-9000
Mailing address
17837 ASHWORTH AVE N, SHORELINE, WA 98133-5018
(425) 387-9416
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.PA.70092411
WA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
10/14/2024
Last updated
04/08/2026
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