Individual
SAMUEL EDWARD RUSSETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9300 NE OAK VIEW DR, VANCOUVER, WA 98662-6157
(360) 567-2211
Mailing address
12901 NE 28TH ST APT 133, VANCOUVER, WA 98682-1229
(700) 969-0488
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/02/2018
Last updated
12/27/2018
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