Individual
RUSSELL LARDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
4515 MARTIN LUTHER KING JR WAY, SEATTLE, WA 98108
(206) 320-5325
Mailing address
1776 S COLUMBIAN WAY, SEATTLE, WA 98108-1534
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RN00138452
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN00138452
RN
WA
Enumeration date
08/27/2012
Last updated
09/10/2012
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