Individual
ANDREA RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM
Contact information
Practice address
5257 NE MARTIN LUTHER KING JR STE 201, PORTLAND, OR 97211-3283
(503) 851-0059
(503) 430-5403
Mailing address
5257 NE MARTIN LUTHER KING JR STE 201, PORTLAND, OR 97211-3283
(503) 851-0059
(503) 430-5403
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
17-CRM-099
OR
Other
Enumeration date
06/08/2017
Last updated
07/21/2022
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