Individual
MRS. CARRIE ELIZABETH RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NTP
Contact information
Practice address
650 SW MEADOW DR, SUITE 121, BEAVERTON, OR 97006-7130
(971) 563-5300
Mailing address
650 SW MEADOW DR, SUITE 121, BEAVERTON, OR 97006-7130
(971) 563-5300
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
001012
OR
Other
Enumeration date
05/31/2011
Last updated
05/31/2011
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