Individual
JESSICA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1910 BLACK LAKE BLVD SW, OLYMPIA, WA 98512-5651
(360) 706-8771
Mailing address
PO BOX 1123, TENINO, WA 98589-1123
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP60045967
WA
Other
Enumeration date
05/18/2026
Last updated
05/18/2026
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