Individual
MS. TRACEY MARIE RUSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3445 BOONE RD SE, SALEM, OR 97317-9336
(503) 576-3000
Mailing address
33815 SE PEORIA ROAD, CORVALLIS, OR 97333
(720) 352-6745
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
0012073
CO
Other
Enumeration date
03/25/2016
Last updated
03/25/2016
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