Individual
STEPHANIE ALICE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN, LD
Contact information
Practice address
369 NE REVERE AVE STE 105, BEND, OR 97701-4082
(541) 323-3488
(541) 323-3483
Mailing address
369 NE REVERE AVE STE 105, BEND, OR 97701-4082
(541) 323-3488
(541) 323-3483
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
987692
WA
133V00000X
Registered Dietitian
Primary
LD-D-10255383
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
987692
CDR
WA
01
—
DI00002073
DOH/CD
WA
Enumeration date
02/13/2008
Last updated
11/26/2025
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