Individual
MR. RUSSELL LOYD HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
595 SW BLUFF DR STE A, BEND, OR 97702
(541) 728-2063
Mailing address
PO BOX 70673, SPRINGFIELD, OR 97475-0133
(541) 248-9556
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201401588NP-PP
OR
Other
Enumeration date
01/16/2013
Last updated
07/11/2018
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