Individual
SAMANTHA RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM
Contact information
Practice address
466 NW 3RD ST, SUITE 104, PRINEVILLE, OR 97754
(541) 388-8459
Mailing address
1333 NW 9TH ST, PRINEVILLE, OR 97754-1482
(541) 388-8459
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/25/2022
Last updated
11/25/2022
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