Russell, Theresa A
Russell, Theresa A is an individual health care provider with primary practice located at 406 Ne 1St St , Enterprise OR 97828-1168. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Russell, Theresa A can be contacted via phone (541) 426-4502.Contact Information
Primary practice address
406 Ne 1St St
Enterprise OR 97828-1168
Phone: (541) 426-4502
Fax: (541) 426-6403
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 91000286 | Oregon |
Profile Details
| NPI number | 1629061981 |
|---|---|
| LBN Legal business name | Russell, Theresa A |
| Credentials | Family Nurse Practitioner (FNP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 23rd, 2005 |
| Last updated | Dec 13th, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629061981 | NPPES |
| Oregon | Other | 5966011 | BCBS |
| Oregon | Other | J054905 | BCBS |
| Oregon | MEDICAID | 276716 | BCBS |
| Oregon | Other | 500008058 | BCBS |
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