Individual
CHARITY DENEISE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
12501 NW 19TH AVE, VANCOUVER, WA 98685-2416
(360) 773-7927
Mailing address
12501 NW 19TH AVE, VANCOUVER, WA 98685-2416
(360) 773-7927
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP60300776
WA
Other
Enumeration date
11/18/2024
Last updated
11/18/2024
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