Individual
MARY MARGARET RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Mailing address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
31549
MT
363LG0600X
Gerontology Nurse Practitioner
Primary
AP30004243
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801992466
—
WA
01
—
P01501773
RR MEDICARE
WA
Enumeration date
09/14/2006
Last updated
09/28/2015
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